WO2005099562B1 - Non-invasive measurement of second heart sound components - Google Patents

Non-invasive measurement of second heart sound components

Info

Publication number
WO2005099562B1
WO2005099562B1 PCT/CA2005/000568 CA2005000568W WO2005099562B1 WO 2005099562 B1 WO2005099562 B1 WO 2005099562B1 CA 2005000568 W CA2005000568 W CA 2005000568W WO 2005099562 B1 WO2005099562 B1 WO 2005099562B1
Authority
WO
WIPO (PCT)
Prior art keywords
peak
component
pulmonary
location
peaks
Prior art date
Application number
PCT/CA2005/000568
Other languages
French (fr)
Other versions
WO2005099562A1 (en
Inventor
Boris Popov
Victor F Lanzo
Rajeev Agarwal
Original Assignee
Andromed Inc
Boris Popov
Victor F Lanzo
Rajeev Agarwal
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Andromed Inc, Boris Popov, Victor F Lanzo, Rajeev Agarwal filed Critical Andromed Inc
Priority to US11/578,462 priority Critical patent/US7909772B2/en
Priority to EP05734306A priority patent/EP1744666A1/en
Priority to JP2007507636A priority patent/JP2007532207A/en
Priority to CA002569730A priority patent/CA2569730A1/en
Publication of WO2005099562A1 publication Critical patent/WO2005099562A1/en
Publication of WO2005099562B1 publication Critical patent/WO2005099562B1/en
Priority to US13/053,202 priority patent/US20120071767A1/en

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/021—Measuring pressure in heart or blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/346—Analysis of electrocardiograms
    • A61B5/349—Detecting specific parameters of the electrocardiograph cycle
    • A61B5/352—Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B7/00—Instruments for auscultation
    • A61B7/02—Stethoscopes
    • A61B7/04—Electric stethoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/369—Electroencephalography [EEG]

Abstract

A method and apparatus for estimating a location of pulmonary and aortic components of second heart sounds of a patient over an interval. The method comprises the steps of producing an electronic representation of heart sounds of the patient over the interval, identifying at least one second heart sound in the interval using the electronic representation, for each identified second heart sound generating an estimated value for a location of the aortic component and the pulmonary component. There is also included a method for using the estimated location of the aortic component and the pulmonary component for estimation of the blood pressure in the pulmonary artery of a patient.

Claims

AMENDED CLAIMS received by the International Bureau on 21 November 2005 (21.11.2005) original claims 1-24, replaced by claims 1-40.WHAT IS CLAIMED IS:
1. A method for estimating a location of pulmonary and aortic components of second heart sounds of a patient over an interval, the method comprising the steps of: producing an electronic representation of heart sounds of the patient over the interval; identifying at least one second heart sound in the interval using said electronic representation; for each identified second heart sound: calculating a frequency weighted energy (FWE); normalising said FWE; identifying peaks in said FWE; determining a maximum peak from said identified peaks; and retaining said maximum peak and peaks having an amplitude within a predetermined amount of an amplitude of said maximum peak; wherein if two or more peaks are retained, two largest peaks are selected, a first peak as a candidate value for the aortic component and a second peak as a candidate value for the pulmonary component, wherein said first peak is prior to said second peak and wherein if only a single peak is retained, said single peak is selected as a candidate value for the aortic component; and generating an estimated value for a location of the aortic component and the pulmonary component from said candidate values.
2. The method of Claim 1 , wherein said second heart sound identifying step comprises framing said second heart using a reference signal.
3. The method of Claim 2, wherein said reference signal is an ECG of the patient.
23
4. The method of Claim 1 , wherein said FWE calculating step comprises generating a Non Linear Energy Operator (NLEO) function for each identified second heart sound.
5. The method of Claim 4, wherein said NLEO function x¥[n] = x(n-l)-x(n-m)-x(n-p)-x(n-q) for l + m = p + q , I ≠ p and q ≠ m.
6. The method of Claim 5, wherein I = 2, m = 3, q = 4 and p = 1.
7. The method of Claim 4, wherein in said peak identifying step, a maximum peak value is identified and any identified peak having a value less than a predetermined amount of said maximum peak value are discarded.
8. The method of Claim 7, wherein said predetermined amount is between 90% and 100%.
9. The method of Claim 1 , wherein said peak identifying step comprises identifying all local maxima which are greater than a predetermined distance apart, wherein each of said identified local maxima is a peak.
10. The method of Claim 9, wherein said predetermined distance is at least 10 ms.
11. The method of Claim 1 , wherein said predetermined value is between 0 and 10% of said maximum candidate value.
12. The method of Claim 1 , wherein said estimated value generating step comprises: generating a first probability distribution of locations of said remaining aortic component candidate values relative to a predetermined point of their respective second heart sounds and a second probability distribution of locations of said remaining pulmonary component candidate values relative to a predetermined point of their respective second heart sounds; and identifying a first local maximum in said first probability distribution and a second local maximum in said second probability distribution; wherein a location of said first local maximum is the location of the aortic component and a location of said second local maximum is the location of the pulmonary component.
13. The method of Claim 12, wherein said predetermined point is a start of said respective second heart sound.
14. The method of Claim 1 , further comprising, for each identified second heart sound and prior to said FWE calculating step, a signal to noise ratio (SNR) calculating step wherein when said calculated SNR is below a predetermined ratio, no candidate values for the aortic component or the pulmonary component are selected.
15. The method of Claim 14, wherein said SNR calculating step comprises detecting a start and finish of said identified second heart sound, calculating an average signal energy between said start and finish, calculating an average noise energy for a predetermined period before said start and after said finish, wherein said SNR is equal to said average signal energy divided by said average noise energy.
16. The method of Claim 15, wherein said predetermined period is 50ms.
17. The method of Claim 14, wherein said predetermined ratio is 0.50.
18. A method for estimating a location of pulmonary and aortic
25 components of second heart sounds of a patient over an interval, the method comprising the steps of: producing an electronic representation of heart sounds of the patient over the interval; dividing said electronic representation into a plurality of sub-channels; for each of said sub-channel representations: identifying at least one second heart sound in the interval using said electronic representation; and extracting an estimated location of a sub-channel aortic component and a sub-channel pulmonary component from said at least one second heart sound; combining said estimated sub-channel aortic component locations to form the estimated aortic component location and said estimated sub-channel pulmonary component locations to form the estimated pulmonary component location.
19. The method of Claim 18, wherein said extracting step comprises: for each identified second heart sound: calculating a FWE; normalising said FWE; identifying peaks in said FWE; determining a maximum peak from said identified peaks; and retaining said maximum peak and peaks having an amplitude within a predetermined amount of an amplitude of said maximum peak; wherein if two or more peaks are retained, two largest peaks are selected, a first peak as a candidate value for the aortic component and a second peak as a candidate value for the pulmonary component, wherein said first peak is prior to said second peak and wherein if only a single peak is retained, said single peak is selected as a candidate value for the aortic component; and
26 generating said estimated location of an aortic component and a pulmonary component from said candidate values.
20. The method of Claim 18, wherein said electronic representation is divided into a low frequency channel, a medium frequency channel and a high frequency channel.
21. The method of Claim 20, wherein said low frequency channel is from 30 to 50 Hz, said medium frequency channel from 50 to 120 Hz and said high frequency channel from 120 to 200 Hz.
22. A method for estimating a location of pulmonary and aortic components of second heart sounds a patient over an interval, the method comprising the steps of: positioning a first transducer at a first position on the patient, said first transducer producing a first electronic representation of heart sounds of the patient over the interval; positioning a second transducer at a second position on the patient, said second transducer producing a second electronic representation of heart sounds of the patient over the interval; for said first electronic representation: identifying at least one second heart sound in the interval; for each identified second heart sound: calculating a FWE; normalising said FWE; identifying peaks in said FWE; determining a maximum peak from said identified peaks; and retaining said maximum peak and peaks having an amplitude within a predetermined amount of an amplitude of said maximum peak; wherein if two or more peaks are retained, two largest
27 peaks are selected, a first peak as a candidate value for the aortic component and a second peak as a candidate value for the pulmonary component, wherein said first peak is prior to said second peak and wherein if only a single peak is retained, said single peak is selected as a candidate value for the aortic component; and generating a first estimated value for a location of an aortic component and a pulmonary component from said candidate values; and for said second electronic representation: identifying at least one second heart sound in the interval; for each identified second heart sound: calculating a FWE; normalising said FWE; identifying peaks in said FWE; determining a maximum peak from said identified peaks; and retaining said maximum peak and peaks having an amplitude within a predetermined amount of an amplitude of said maximum peak; wherein if two or more peaks are retained, two largest peaks are selected, a first peak as a candidate value for the aortic component and a second peak as a candidate value for the pulmonary component, wherein said first peak is prior to said second peak and wherein if only a single peak is retained, said single peak is selected as a candidate value for the aortic component; and generating second estimated values for a location of the aortic component and the pulmonary component from said candidate values; and combining said first and second estimated aortic location values and said first and second estimated pulmonary location values;
28 wherein the estimated location of the aortic components is said combined first and second estimated aortic location values and the estimated location of the pulmonary components is said combined first and second estimated pulmonary location values.
23. The method of Claim 22, wherein said first position is at an apex of the patient's heart.
24. The method of Claim 22, wherein said second position between a is between the patient's 3rd and 4th left intercostals space.
25. A method for estimating pulmonary artery pressure of a patient over an interval, the method comprising the steps of: producing an electronic representation of heart sounds of the patient over the interval; identifying at least one second heart sound in the interval using said electronic representation; for each identified second heart sound: calculating a FWE; normalising said FWE; identifying peaks in said FWE; determining a maximum peak from said identified peaks; and retaining said maximum peak and peaks having an amplitude within a predetermined amount of an amplitude of said maximum peak; wherein if two or more peaks are retained, two largest peaks are selected, a first peak as a candidate value for the aortic component and a second peak as a candidate value for the pulmonary component, wherein said first peak is prior to said second peak and wherein if only a single peak is retained, said single peak is selected as a candidate value for the aortic component; and
29 generating an estimated value for a location of an aortic component and a location of pulmonary component from said candidate values; determining a splitting interval as a time between said aortic component location and said pulmonary component location; normalising said splitting interval; and estimating the systolic and diastolic pulmonary artery pressure using a predetermined function which describes a relationship between said normalised splitting interval and the systolic and diastolic pulmonary artery pressures.
26. An apparatus implementing any of the methods of claims 1 through 25.
27. A device for estimating a location of pulmonary and aortic components of second heart sounds of a patient over an interval, the device comprising: at least one transducer for sensing heart sounds of the patient, said heart sounds comprising, during motion of the patient, a first sound portion indicative of second heart sounds and a second sound portion indicative of motion induced noise; and a second heart sound processor to identify second heart sounds from said sensed heart sounds and compute an aortic component location and an estimated pulmonary component location from said identified second heart sounds without significant interference in said identification and computation from the motioned induced noise portion of said sensed heart sounds.
28. The device of Claim 27, wherein said second heart sound processor comprises: a means for identifying at least one second heart sound in the interval using said sensed heart sounds; a means for calculating a frequency weighted energy (FWE) of each
30 identified second heart sound; a means for normalising said calculated FWE of each identified second heart sound; a means for identifying peaks in said calculated FWE of each identified second heart sound and determining a maximum peak from said identified peaks; and a means for retaining said maximum peak and peaks having an amplitude within a predetermined amount of an amplitude of said maximum peak wherein if two or more peaks are retained, two largest peaks are selected, a first peak as a candidate value for the aortic component and a second peak as a candidate value for the pulmonary component, wherein said first peak is prior to said second peak and wherein if only a single peak is retained, said single peak is selected as a candidate value for the aortic component; and a means for generating an estimated value for a location of the aortic component and the pulmonary component from said candidate values.
29. The device of Claim 28, wherein said second heart sound identifying means frames said second heart using a reference signal.
30. The device of Claim 29, wherein said reference signal is an ECG of the patient.
31. The device of Claim 28, wherein said FWE calculating means generates a Non Linear Energy Operator (NLEO) function for each identified second heart sound.
32. The device of Claim 31 , wherein said NLEO function x¥[n] = x(n-l)-x(n-m)-x(n-p)-x(n-q) for l + m = p + q , I ≠ p and q ≠ m.
31
33. The device of Claim 32, wherein I = 2, m = 3, q = 4 and p = 1.
34. The device of Claim 31 , wherein said peak identifying means identifies a maximum peak value and discards any identified peak having a value less than a predetermined amount of said maximum peak value.
35. The device of Claim 34, wherein said predetermined amount is between 90% and 100%.
36. The device of Claim 28, wherein said peak identifying means identifies all local maxima which are greater than a predetermined distance apart, wherein each of said identified local maxima is a peak.
37. The device of Claim 36, wherein said predetermined distance is at least 10 ms.
38. The device of Claim 28, wherein said predetermined value is between 0 and 10% of said maximum candidate value.
39. A device for estimating the systolic and diastolic pulmonary artery pressure of a patient over an interval, the device comprising: at least one transducer for sensing heart sounds of the patient, said heart sounds comprising, during motion of the patient, a first sound portion indicative of second heart sounds and a second sound portion indicative of motion induced noise; and a processor, said processor: computing an aortic component location and a pulmonary component location from said identified second heart sounds without significant interference in said computation from the motioned induced noise portion of said sensed heart sounds; calculating a normalised splitting interval from said aortic
32 component location and said pulmonary component location; and estimating the systolic and diastolic pulmonary artery pressure using a predetermined function which describes a relationship between said normalised splitting interval and the systolic and diastolic pulmonary artery pressures.
40. The device of Claim 39, further comprising a display means for displaying the systolic and diastolic pulmonary artery pressures.
33
PCT/CA2005/000568 2004-04-16 2005-04-15 Non-invasive measurement of second heart sound components WO2005099562A1 (en)

Priority Applications (5)

Application Number Priority Date Filing Date Title
US11/578,462 US7909772B2 (en) 2004-04-16 2005-04-15 Non-invasive measurement of second heart sound components
EP05734306A EP1744666A1 (en) 2004-04-16 2005-04-15 Non-invasive measurement of second heart sound components
JP2007507636A JP2007532207A (en) 2004-04-16 2005-04-15 Non-invasive measurement method for the second heart sound component
CA002569730A CA2569730A1 (en) 2004-04-16 2005-04-15 Non-invasive measurement of second heart sound components
US13/053,202 US20120071767A1 (en) 2004-04-16 2011-03-21 Pulmonary artery pressure estimator

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US56253804P 2004-04-16 2004-04-16
US60/562,538 2004-04-16
CA2,464,634 2004-04-16
CA002464634A CA2464634A1 (en) 2004-04-16 2004-04-16 Pap estimator

Related Child Applications (2)

Application Number Title Priority Date Filing Date
US11/578,462 A-371-Of-International US7909772B2 (en) 2004-04-16 2005-04-15 Non-invasive measurement of second heart sound components
US13/053,202 Continuation US20120071767A1 (en) 2004-04-16 2011-03-21 Pulmonary artery pressure estimator

Publications (2)

Publication Number Publication Date
WO2005099562A1 WO2005099562A1 (en) 2005-10-27
WO2005099562B1 true WO2005099562B1 (en) 2006-03-16

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US (2) US7909772B2 (en)
EP (1) EP1744666A1 (en)
JP (1) JP2007532207A (en)
CA (2) CA2464634A1 (en)
WO (1) WO2005099562A1 (en)

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