Hemodynamic status assessment

A system for determining a hemodynamic status model and providing therapy based on the hemodynamic status model, the system comprising:

• a lead connector electrically connectable to at least two electrodes of at least one electric lead;
• a signal generator connected to the lead connector and configured to generate, during a period of normal hemodynamic status of a subject and in connection with a period of abnormal hemodynamic status of the subject, electric signals applicable over two electrodes of the at least two electrodes;
• a signal sensing unit connected to the lead connector and configured to sense, during the period of normal hemodynamic status of the subject and in connection with the period of abnormal hemodynamic status of the subject, resulting electric signals over two electrodes of the at least two electrodes;
• an impedance processor configured to determine a first impedance signals based on the electric signals applied and the resulting electric signals sensed during the period of normal hemodynamic status of the subject and determine a second impedance signal based on the electric signals applied and the resulting electric signals sensed in connection with the period of abnormal hemodynamic status of the subject;
• a parameter processor configured to calculate first parameter values of a set of N different impedance-derivable parameters based on the first impedance signal and calculate second parameter values of the set of N different impedance-derivable parameters based on the second impedance signal, N is a positive integer equal to or larger than two;
• a model processor configured to estimate, based on the first parameter values and the second parameter values, N+1 coefficients of a linear parametric status model
• Index
• j
• =
• c
• 0
• +
• ∑
• i
• =
• 1
• N
• ⁢
• ⁢
• c
• i
• ⁢
• f
• i
• j
• ,
• where j=1, 2C0, Ci represent the N+1 coefficients, fi1 represent the first parameter values, fi2 represent the second parameter values, Index1 has a predefined first value representative of normal hemodynamic status of the subject and Index2 has a predefined second value representative of abnormal hemodynamic status of the subject;
• a memory configured to store the N+1 coefficients as representations of the linear parametric status model;
• a posture sensor configured to generate a posture signal representative of a current posture of the subject, wherein
• the signal generator is configured to generate, during the period of normal hemodynamic status of the subject and when the posture signal represents a first predefined posture of the subject, during the period of normal hemodynamic status of the subject and when the posture signal represents a second predefined posture of the subject, in connection with the period of abnormal hemodynamic status of the subject and when the posture signal represents the first predefined posture of the subject, and in connection with the period of abnormal hemodynamic status of the subject and when the posture signal represents the second predefined posture of the subject, the electric signals applicable over two electrodes of the at least two electrodes;
• the signal sensing unit is configured to sense, during the period of normal hemodynamic status of the subject and when the posture signal represents the first predefined posture of the subject, during the period of normal hemodynamic status of the subject and when the posture signal represents the second predefined posture of the subject, in connection with the period of abnormal hemodynamic status of the subject and when the posture signal represents the first predefined posture of the subject, and in connection with the period of abnormal hemodynamic status of the subject and when the posture signal represents the second predefined posture of the subject, the resulting electric signals over two electrodes of the at least two electrodes;
• the impedance process or is configured to determine the first impedance signal based on the electric signals applied and the resulting electric signals sensed during the period of normal hemodynamic status of the subject and when the posture signal represents the first predefined posture of the subject, determine the second impedance signal based on the electric signals applied and the resulting electric signals sensed in connection with the period of abnormal hemodynamic status of the subject and when the posture signal represents the first predefined posture of the subject, determine a third impedance signal based on the electric signals applied and the resulting electric signals sensed during the period of normal hemodynamic status of the subject, and when the posture signal represents the second predefined posture of the subject, and determine a fourth impedance signal based on the electric signals applied and the resulting electric signals sensed in connection with the period of abnormal hemodynamic status of the subject and when the posture signal represents the second predefined posture of the subject;
• the parameter processor is configured to calculate the first parameter values of the set of N different impedance-derivable parameters based on the first impedance signal, calculate the second parameter values of the set of N different impedance-derivable parameters based on the second impedance signal, calculate third parameter values of the set of N different impedance-derivable parameters based on the third impedance signal and calculate fourth parameter values of the set of N different impedance-derivable parameters based on the fourth impedance signal;
• the model processor is configured to estimate, based on the first parameter values and the second parameter values, N+1 coefficients of a first linear parametric status model
• Index
• 1
• j
• =
• c
• 0
• +
• ∑
• i
• =
• 1
• N
• ⁢
• c
• i
• ⁢
• f
• i
• j
• ,
• where j=1, 2, c0, ci represent the N+1 coefficients, fi1 represent the first parameter values, fi2 represent the second parameter values, Index11 has the predefined first value representative of normal hemodynamic status of the subject and Index12 has the predefined second value representative of abnormal hemodynamic status of the subject and estimate, based on the third parameter values and the fourth parameter values, N+1 coefficients of a second linear parametric status model
• Index
• 2
• j
• =
• d
• 0
• +
• ∑
• i
• =
• 1
• N
• ⁢
• d
• i
• ⁢
• g
• i
• j
• ,
• where j=1, 2, d0, di represent the N+1 coefficients, gi1 represent the third parameter values, gi2 represent the fourth parameter values, Index21 has the predefined first value representative of normal hemodynamic status of the subject and Index22 has the predefined second value representative of abnormal hemodynamic status of the subject;
• the memory is configured to store the 2(N+1) coefficients as representations of the first and second linear parametric status models;
• and
• a therapy selector to provide therapy based on the determined hemodynamic status of the subject.

An implantable medical device comprising:

• a lead connector electrically connectable to at least two electrodes of the at least one electric lead;
• a signal generator connected to the lead connector and configured to generate, during a status assessment period, electric signals applicable over two electrodes of the at least two electrodes;
• a signal sensing unit connected to the lead connector and configured to sense, during the status assessment period, resulting electric signals over two electrodes of the at least two electrodes;
• an impedance processor configured to determine an impedance signal based on the electric signals applied and the resulting electric signals sensed during the status assessment period;
• a parameter processor configured to calculate parameter values of a set of N different impedance-derivable parameters based on the impedance signal;
• a status processor configured to a calculate an index representative of a current hemodynamic status of a subject based on the parameter values calculated by the parameter processor and N+1 coefficients of a linear parametric status model
• Index
• =
• c
• 0
• +
• ∑
• i
• =
• 1
• N
• ⁢
• c
• i
• ⁢
• f
• i
• ,
• wherein c0, ci represent the N+1 coeffieients and fi represent the parameter values calculated by the d parameter processor;
• a posture sensor configured to generate a posture signal representative of a current posture of the subject;
• and
• a model selector configured to select between a first linear parametric status model
• Index
• 1
• =
• c
• 0
• +
• ∑
• i
• =
• 1
• N
• ⁢
• c
• i
• ⁢
• f
• i
• and a second linear parametric status model
• Index
• 2
• =
• d
• 0
• +
• ∑
• i
• =
• 1
• N
• ⁢
• d
• i
• ⁢
• f
• i
• based on the posture signal, wherein c0, ci represent N+1 coefficients applicable when the subject is in a first posture and d0, di represent N+1 coefficients applicable when the subject is in a second posture;
• and
• a therapy selector to provide therapy based on the determined hemodynamic status of the subject.

A method of determining a hemodynamic status model, and providing therapy based on the hemodynamic status model, the method comprising:

• generating, during a period of normal hemodynamic status of a subject and in connection with a period of abnormal hemodynamic status of the subject, electric signals applicable over two electrodes of at least one electric lead;
• sensing, during the period of normal hemodynamic status of the subject and in connection with the period of abnormal hemodynamic status of the subject, resulting electric signals over two electrodes of the at least one electric lead;
• determining a first impedance signal based on the electric signals applied and the resulting electric signals sensed during the period of normal hemodynamic status of the subject;
• determining a second impedance signal based on the electric signals applied and the resulting electric signals sensed in connection with the period of abnormal hemodynamic status of the subject;
• calculating first parameter values of a set of N different impedance-derivable parameters based on the first impedance signal;
• calculating second parameter values of the set of N different impedance-derivable parameters based on the second impedance signal, N is a positive integer equal to or larger than two;
• estimating, based on the first parameter values and the second parameter values, N+1 coefficients of a linear parametric status model
• Index
• j
• =
• c
• 0
• +
• ∑
• i
• =
• 1
• N
• ⁢
• c
• i
• ⁢
• f
• i
• j
• ,
• where j=1, 2c0, ci represent N+1 coefficients, fi1 represent the first parameter values, fi2 represent the second parameter values, Index1 has a predefined first value representative of normal hemodynamic status of the subject;
• and Index2 has a predefined second value representative of abnormal hemodynamic status of the subject;
• storing said N+1 coefficients as representations of the linear parametric status model in a memory;
• detecting a tachyarrhythmia period of the subject based on electric signals sensed from a heart of the subject by at least one electric lead of the at least one electric lead, wherein
• generating the electric signals in connection with the period of abnormal hemodynamic status comprises generating, in connection with the period of abnormal hemodynamic status of the subject and in response to the detected tachyarrhythmia period, the electric signals applicable over the two electrodes;
• sensing the resulting electric signals in connection with the period of abnormal hemodynamic status comprises sensing, in connection with the period of abnormal hemodynamic status of the subject and in response to the detected tachyarrhythmia period, the resulting electric signals over the two electrodes;
• and
• providing therapy based on the determined hemodynamic status of the subject.

A method of determining a hemodynamic status model and providing therapy based on the hemodynamic status model, the method comprising:

• generating, during a period of normal hemodynamic status of a subject and in connection with a period of abnormal hemodynamic status of the subject, electric signals applicable over two electrodes of at least one electric lead;
• sensing, during the period of normal hemodynamic status of the subject and in connection wit the period of abnormal hemodynamic status of the subject, resulting electric signals over two electrodes of the at least one electric lead;
• determining a first impedance signal based on the electric signals applied and the resulting electric signals sensed during the period of normal hemodynamic status of the subject;
• determining a second impedance signal based on the electric signals applied and the resulting electric signals sensed in connection with the period of abnormal hemodynamic status of the subject;
• calculating first parameter values of a set of N different impedance-derivable parameters based on the first impedance signal;
• calculating second parameter values of the set of N different impedance-derivable parameters based on the second impedance signal, N is a positive integer equal to or larger than two;
• estimation, based on the first parameter values and the second parameter values, N+1 coefficients of a linear parametric status model
• Index
• j
• =
• c
• 0
• +
• ∑
• i
• =
• 1
• N
• ⁢
• ⁢
• c
• i
• ⁢
• f
• i
• j
• ,
• where j=1, 2c0, ci represent said N+1 coefficients, fi1 respesent the first parameter values, fi2 represent the second parameter values, Index1 has a predefined first value representative of normal hemodynamic status of the subject and Index2 has a predefined second value representative of abnormal hemodynamic status of the subject;
• storing said N+1 coefficients as representations of the linear parametric status model in a memory;
• detecting a current posture of the subject, wherein
• generating the electric signals comprises generating, during the period of normal hemodynamic status of the subject and when the current posture is a first predefined posture of the subject, during the period of normal hemodynamic status of the subject and when the current posture is a second predefined posture of the subject, in connection with the period of abnormal hemodynamic status of the subject and when the current posture is the first predefined posture of the subject, and in connection with the period of abnormal hemodynamic status of the subject and when the current posture is the second predefined posture of the subject, the electric signals applicable over the two electrodes;
• sensing the resulting electric signals comprises sensing, during the period of normal hemodynamic status of the subject and when the current posture is the first predefined posture of the subject, during the period of normal hemodynamic status of the subject and when the current posture is the second predefined posture of the subject, in connection with the period of abnormal hemodynamic status of the subject and when the current posture is the first predefined posture of the subject, and in connection with the period of abnormal hemodynamic status of the subject and when the current posture is the second predefined posture of the subject, the resulting electric signals over the two electrodes;
• determining the first impedance signal comprises determining the first impedance signal based on the electric signals applied and the resulting electric signals sensed during the period of normal hemodynamic status of subject and when the current posture is the first predefined posture of the subject;
• determining the second impedance signal comprises determining the second impedance signal based on the electric signals applied and the resulting electric signals sensed in connection with the period of abnormal hemodynamic status of the subject and when the current posture is the first predefined posture of the subject, the method further comprises:
• determining a third impedance signal based on the electric signals applied and the resulting electric signals sensed during the period of normal hemodynamic status of the subject and when current posture is the second predefined posture of the subject;
• determining a fourth impedance signal based on the electric signals applied and the resulting electric signals sensed in connection with the period of abnormal hemodynamic status of the subject and when the current posture is the second predefined posture of the subject;
• calculating third parameter values of the set of N different impedance-derivable parameters based on the third impedance signal;
• and
• calculating fourth parameter values of the set of N different impedance-derivable parameters based on the fourth impedance signal, wherein estimating the N+1 coefficients comprises:
• estimating, based on the first parameter values and the second parameter values, N+1 coefficients of a first linear parametric status model
• Index
• 1
• j
• =
• c
• 0
• +
• ∑
• i
• =
• 1
• N
• ⁢
• c
• i
• ⁢
• f
• i
• j
• ,
• where j=1, 2, c0, ci represent the N+1 coefficients, fi1 represent the first parameter values, fi2 represent the second parameter values, Index11 has the predefined first value representative of normal hemodynamic status of the subject and Index12 has the predefined second value representative of abnormal hemodynamic status of the subject;
• estimating, based on the third parameter values and the fourth parameter values, N+1 coefficients of a second linear parametric status model
• Index
• 2
• j
• =
• d
• 0
• +
• ∑
• i
• =
• 1
• N
• ⁢
• d
• i
• ⁢
• g
• i
• j
• ,
• where j=1, 2, d0, di represent the N+1 coefficients, gi1 represent the third parameter values, gi2 represent the fourth parameter values, Index21 has the predefined first value representative of normal hemodynamic status of the subject and Index22 has the predefined second value representative of abnormal hemodynamic status of the subject;
• and
• storing the N+1 coefficients comprises storing the 2(N+1) coefficients as representations of the first and second linear parametric status models;
• and
• providing therapy based on the determined hemodynamic status of the subject.

A method of assessing a hemodynamic status of a subject and providing therapy based on the hemodynamic status, the method comprising:

• generating, during a status assessment period, electric signals applicable over two electrodes of at least one electric lead;
• sensing, during the status assessment period, resulting electric signals over two electrodes of the at least one electric lead;
• determining an impedance signal based on the electric signals applied and the resulting electric signals sensed during the status assessment period;
• calculating parameter values of a set of N different impedance-derivable parameters based on the impedance signal;
• calculating an index representative of a current hemodynamic status of the subject based on the parameter values and N+1 coefficients of a linear parametric status model
• Index
• =
• c
• 0
• +
• ∑
• i
• =
• 1
• N
• ⁢
• c
• i
• ⁢
• f
• i
• ,
• wherein c0, ci represent the N+1 coefficients and fi represent the parameter values;
• detecting a current posture of the subject;
• selecting between a first linear parametric status model
• Index
• 1
• =
• c
• 0
• +
• ∑
• i
• =
• 1
• N
• ⁢
• c
• i
• ⁢
• f
• i
• and a second linear parametric status model
• Index
• 2
• =
• d
• 0
• +
• ∑
• i
• =
• 1
• N
• ⁢
• d
• i
• ⁢
• f
• i
• based on the current posture, wherein c0, ci represent N+1 coefficients applicable when the subject is in a first posture and d0, di represent N+1 coefficients applicable when the subject is in a second posture;
• and
• providing therapy based on the determined hemodynamic status of the subject.