• 专利附录
  • 专利说明
  • 权利要求
  • 类似技术
  • 同族专利
  • 引用文献
  • 法律状态
  • 优先权
    • 专利摘要:
    We propose a method and apparatus to estimate the arterial pulse transit time (ptt) in different arterial segments from measurements made with sensors arranged only in distal areas of the two upper extremities or the two lower extremities. First, the arrival of the pulse wave is detected in an area of the extremities proximal to the torso in the impedance plethysmogram (ipg) measured between the two upper extremities or between the two lower extremities, which reflects changes in areas more proximal with respect to the area where the measuring electrodes are arranged. Second, another time reference is obtained from a pulse signal measured in a distal area with traditional methods. When the first pulse signal is the ipg between the two upper extremities, the second pulse signal may be the ipg between the two lower extremities. The ptt is estimated from the time interval measured between the respective moments of arrival of the pulse wave in the first and in the second signal. (Machine-translation by Google Translate, not legally binding)
    公开号:ES2616740A1
    申请号:ES201531645
    申请日:2015-11-13
    公开日:2017-06-14
    发明作者:Ramon Pallàs Areny；Ramon Casanella Alonso；Joan GÓMEZ CLAPERS
    申请人:Universitat Politecnica de Catalunya UPC；
    IPC主号:
    专利说明:

    SECTOR OF THE TECHNIQUE
    The present invention concerns, in general, the measurement systems of
    10 physiological parameters by physical methods and, in particular, to a method and apparatus for estimating the transit time of the arterial pulse from measurements obtained by sensors arranged exclusively in distal areas of the extremities.
    STATE OF THE TECHNIQUE
    15 The pulse transit time (Pulse Transit Time or PTT) generated by the ejection of blood from the heart to the arterial system is defined as the time interval between the arrival of the pulse wave at a point proximal to the heart and the arrival of the pulse wave of the same beat to another distal point, and is a very important parameter
    20 to diagnose the state of the cardiovascular system. From the PTT, for example, arterial elasticity can be evaluated, which is a widely accepted indicator to predict the risk of cardiovascular disease. Arterial elasticity has been associated with the presence of cardiovascular risk factors and arteriosclerotic diseases, and their ability to predict future risk
    25 cardiovascular events such as myocardial infarction, stroke, revascularization or aortic syndromes, among others, have been widely corroborated, as described in the document of C. Vlachopoulos, K. Aznaouridis, and C. Stefanadis, "Prediction of Cardiovascular Events and AII-cause Mortality With Arterial Stiffness: a Systematic Review and Meta-analysis, "Joumal American College
    30 Cardio / ogy, vol. 55, no. 13, pp. 1318-27, Mar. 2010.
    Another parameter closely related to the elasticity of an artery is blood pressure, since the modulus of elasticity of an artery E depends on changes in the mean arterial pressure P according to where Eo is the modulus of elasticity of the artery a an average reference blood pressure yk is a constant that depends on the artery considered, and whose value is between 0.016 mmHg · 1 and 0.018 mmHg · 1. Therefore, changes in PTT induced by changes in the modulus of elasticity of the aorta and other arteries,
    5 can be used to estimate changes in blood pressure, and also absolute pressure values by different calibration methods, as described for example in the document of D. Buxi, JM Redouté, and MR Yuce, "A Survey on Signals and Systems in Ambulatory Blood Pressure Monitoring Using Pulse Transit Time, »Physiol. Meas. 001 10.1088 / 0967 -3334 / 36/3 / R1.
    10 Among the arteries of the human body, the elasticity of the aorta is the one with the greatest clinical relevance, since it is responsible for most of the pathophysiological effects derived from arterial stiffness, and constitutes a good indicator of the state of stiffness of the subject arteries. The high predictivity of aortic elasticity
    15 regarding cardiovascular events has been demonstrated in different epidemiological studies, as described in the document of LM Van 80rtel, S. Laurent, P. Boutouyrie, P. Chowienczyk, JK Cruickshank, et al, "Expert Consensus Document on the Measurement of Aortic Stiffness in Daily Practice Using Carotidfemoral Pulse Wave Velocity, "Journal Hypertension, vol. 30, no. 3, pp. 445-448, Mar.
    20 2012. The elasticity of the arteries of a subject can also be assessed from measurements in other large arteries, since it has been shown that changes with medical relevance are also reflected in them, as described, for example in the case of the arteries of the forearm, calf and hand, in the document of 1. Hlimonenko, K. Meigas, M. Viigimaa, and K. Temitski, "Assessment of Pulse Wave
    25 Velocity and Augmentation Index in Different Arteries in Patients With Severe Coronary Heart Disease, »in Engineering in Medicine and Biology Society (EMBS), 2007. 29th Annua // nmation / Conferenee of the / EEE, Aug. 2007, pp. 1703-1706.
    The degree of elasticity of an artery is generally assessed non-invasively to
    30 from the pulse wave velocity (Pulse Wave Velocity or PWV), according to the formula described by Moens-Korteweg,
    PWV = J: r:
    where h is the thickness of the arterial wall, r is the radius of the artery and p is the density
    of the blood. PWV in an artery is obtained from PTT measured between a proximal point and a distal point in that artery, according to
    D
    PWV ~ PTT '
    where D is the distance between the proximal point and the distal point considered.
    5 The usual procedure to measure PTT non-invasively involvespreparation (exposure, cleaning, sensor placement and cable connection) of aproximal measurement point and a distal measurement point with respect to the heart todetect in each of them the arrival of the pulse wave, for example by means of aphotoplethysmograph (PPG) or impedance plethysmograph (IPG) that detect the
    10 local volume change due to the arrival of the arterial pulse, or by means of an arterial tonometer that measures the pressure exerted by a superficial artery on a force sensor in close contact with the skin on it.
    However, the placement of pulse sensors in the torso or in areas near
    15 This requires some expertise and is slow and uncomfortable for the subject, since these areas are usually covered by clothing. One way to speed up PTT measurement is to arrange the distal sensor in the hands or feet, since the former are usually uncovered and the latter are easily accessible, which is especially suitable for measurements in ambulatory settings. However, for
    20 to reduce the uncertainty in the measurement, the distance D between sensors must be large, so a sensor is still required in the torso or in an area near it to detect the arrival of the pulse wave at said proximal point with respect to the heart, which slows and makes measurement difficult.
    25 An alternative to obtain proximal information without having sensors in the torso is to detect the R wave of the ECG, which can be obtained with electrodes in contact with distal areas, such as the hands or feet. However, the time interval measured between the ECG and a distal pulse sensor, called the pulse arrival time (PAT Arrival Time or PAT), includes a part of the so-called pre-period
    Ejection (Pre-Ejection Period, PEP), which is defined as the time between the Q wave of the QRS complex and the opening of the aortic valve, which is the event that marks the start of the arterial pulse wave. The PAT has been used to measure changes in PTT and assess arterial elasticity, as described for example in the cited document of D. Buxi, JM Redouté, and MR Yuce, gA Survey on Signals and Systems in Ambulatory Blood Pressure Monitoring Using Pulse Transit Time, "Physio /. Meas., 001 10.1088 / 0967-3334 / 36/3 / R1, but the use of the ECG as a temporary reference implies that changes in the PAT will only be mainly due to changes in the PTI when PEP changes are comparatively insignificant with respect to those of the
    5 PTI, which discourages the use of PAT as a substitute for PTI. WO 2013017718 A2 describes an apparatus and method for monitoring the cardiovascular system in which time intervals between the ECG and the IPG measured between the upper or lower extremities are measured. The result is the PAT, not the PTI, as it also includes the PEP.
    10 Another alternative way of detecting the arrival of the pulse wave to proximal areas in the torso is from certain fiducial points of the balistocardiogram (BCG), as described in the document of R. Pallas Areny, R. Casan ella and J. GomezClapers, "Method and apparatus for estimating the transit time of the aortic pulse from
    15 of measured time intervals between fiducial points of the balistocardiogram, "P201531414. Since the BCG reflects changes in the center of mass of the human body derived from the mechanical activity related to cardiac ejection, in this document the use of the waves of the BCG as a temporary reference of proximal and distal changes in the aorta to measure the PTI between these waves.
    20 But since the BCG is acquired in subjects standing on a scale, the method and apparatus described in that document do not cover other situations where the subject is not standing and in which it may also be interesting to determine the moments in which events occur cardiovascular in general, and specifically determine the arrival of the pulse wave at proximal and distal points relative to the heart.
    25 Another alternative way to detect the arrival of the pulse wave to proximal areas in the torso is from the measurement of electrical impedance between the neck and the abdomen, which constitutes the so-called impedance cardiogram (Impedance Cardiogram or ICG), and which reflects plethysmographic changes throughout the entire artery
    30 aorta, as described in the document by L. Jensen, J. Yakimets, and K. K. Tea, "A Review of Impedance Cardiography," Hear. Lung J. Acute Crit. Care, vol. 24, no. 3, pp. 183-193, May 1995. However, the ICG requires the injection of an electric current that circulates along the torso, and this is usually achieved by placing electrodes on the neck and abdomen, so obtaining them is little
    35 appropriate for rapid measurements or outside of hospital settings, and even more so when it is not desired to evaluate only the elasticity of the aorta but also that of the arteries of the upper or lower extremities.
    US6228033 81 describes a system for monitoring the cardiovascular system 5 analogously to the ICG and called the whole-body ICG, in which the measurement of thoracic impedance is performed by means of the injection of current between a
    or the two upper extremities on the one hand, and one or both lower extremities on the other, so that it does not require exposure of the torso. However, the measurement of the whole-body ICG always requires the placement of electrodes at least in
    10 an area of the lower extremities and in an area of the upper extremities, so it is not suitable when it is desired to evaluate only the elasticity of the arteries of the upper extremities or the arteries of the lower extremities.
    In WO 2012103296 A2, an apparatus and method for monitoring the cardiovascular system in which the interval between a signal that reflects a movement of blood in the aorta from the ICG measured between upper extremities or between the extremities is described lower and a photoplethysmographic sensor located in a distal area. However, the measurement of plethysmographic variations in the
    20 aorta from a signal of impedance measured between extremities is complicated, since the contribution of these variations to the measured waveform is very small compared to the contributions of other arteries in the extremities, so it is expected that the uncertainty in the value of the measured interval is large.
    25 The use of the IPG measured between the two upper extremities or between the two lower extremities to detect plethysmographic changes in areas proximal to the torso, corresponding to the extremities instead of being associated with changes in the aorta, combined with another pulse sensor located in a distal area of the
    30 upper or lower extremities, would allow to measure the PTT in different arterial segments more quickly, comfortably and reliably than with current methods and systems, since this would prevent the placement of sensors in areas proximal to the torso, which would be very useful to evaluate the elasticity of the arteries and their derived parameters.
    BRIEF DESCRIPTION OF THE INVENTION
    The invention consists of a method and apparatus for estimating the transit time of the arterial pulse (PTI) from measurements obtained by sensors arranged exclusively in distal areas of the extremities.
    The innovative solution proposed by the present invention is the use of the impedance plethysmogram signal measured between the two upper extremities.
    or between the two lower extremities, that is, along the left-right axis
    10 of the human body, to detect plethysmographic changes in areas closer to the torso, corresponding to the proximal part of the extremities, than those areas where the sensors are placed, which in this case are the electrodes that obtain the IPG. This allows to measure the PTT in an arterial segment from the time interval between said plethysmographic signal "from side to side" and another signal provided by a
    15 second pulse wave sensor placed in a distal area of the extremities, either local IPG, that is, with electrodes around a small area of the limb, the PPG, a tonometer, or other sensor of cardiovascular events, such as for example the BCG. Since both the signal from the second sensor and the IPG signal in the proposed method are obtained with measurements by means of sensors arranged or
    20 in distal parts of the upper extremities or of the lower extremities, or placed in a support with which the upper limbs or lower extremities make contact, the ITP can be measured without having to place pulse sensors in areas proximal to the torso and this allows to measure quickly, comfortably and even autonomously when it is the same measured person who enters
    25 contact with the electrodes, instead of having another person put them on the limbs.
    This innovative solution is based on the fact that the IPG signal measured between the two upper extremities or between the two lower extremities reflects plethysmographic changes along the path followed by the injected current. Since the current flows from one side of the body to the other through the torso, in the case of measuring between the two upper extremities it is expected that the waveform of this IPG corresponds to the superposition of plethysmographic changes in the path of the current caused by the arrival of the pulse wave to the different arteries of the upper thorax and upper extremities. However, the contribution of plethysmographic changes in the aorta or torso to the waveform obtained by the IPG measured between the extremities is very small, since arteries with a larger diameter have a lower impedance, so they are difficult to detect With this IPG and its measurement is unreliable. Therefore, the proposed solution 5 in this invention is to detect the arrival of the pulse wave to parts of the upper extremities proximal to the torso, since their contribution to the waveform is much greater and therefore they are more easily detectable. Similarly, the IPG waveform measured between the two lower extremities is expected to correspond to the superposition of plethysmographic changes in the path of the current caused by the arrival of the pulse wave to the different arteries of the lower abdomen and of the lower extremities. Since the contribution of the aortic and iliac arteries to the waveform obtained is very low due to its larger diameter, which implies less impedance, it is proposed to detect the arrival of the pulse wave to parts of the lower extremities proximal to the torso since its
    15 contribution to the waveform is much greater and therefore they are more easily detectable.
    A particular way of measuring PTT from the impedance signal between extremities is by using the BCG. Since the BCG signal, obtained for example by means of the sensors of a scale on which a person is placed, offers temporary information related to cardiac ejection in its initial waves, such as wave 1, and temporal information related to arrival of the pulse wave at the end of the aorta, such as the J wave, as detailed in document P201531414, said I and J waves can be used, in combination with measurements of
    25 IPG between, respectively, the two lower extremities or the two upper extremities, to obtain a PTI that would include the aortic PTI and the PTI of the upper legs or arms, respectively.
    As a result of all this, a method is proposed to estimate the PTI in a section
    30 of the arterial tree consisting, first, of detecting a fiducial point of the pulse wave in the IPG signal measured between the two upper extremities or between the two lower extremities, corresponding to the arrival of the pulse wave to an area proximal to the thorax of said limbs, and a fiducial point of a second signal obtained from a pulse sensor placed in a distal area of a limb such as,
    35 for example, a finger of one hand or one foot, or on a scale in contact with the two lower extremities of a person placed on it. When the first signal is the IPG between the two upper extremities, the second pulse signal may be the IPG between the two lower extremities. Then, whatever the case, the time interval between the fiducial point of the first is measured
    5 IPG signal and the fiducial point of the second pulse signal, and said interval corresponds to the PTI in a certain section of the arterial network.
    Several of the algorithms commonly used to automatically detect the onset of the pulse wave in a beat can be used to detect plethysmographic changes proximal to the torso in the IPG signal measured between the two upper extremities or between the two lower extremities, for example , the detection of its minimum value, of a threshold value of the ascending impulse of the wave (10%, 25%, 50%, etc.), of the maximum of the first derivative, of the maximum of the second derivative, or of the intersection of tangent lines, among others, as detailed by example in X. Zhou, R. Peng, H. Ding, N. Zhang, and P. Lí, "Validation of New and Existing Decision Rules for the Estimation of 8eat-to-8eat Press Transi! Time, "Biomed Res. In /., vol. 2015, Article ID 306934, pp. 1-13, Mar. 2015. The influence of the plethysmographic changes proximal to the torso in the waveform obtained allows these to be detected with any traditional algorithm
    20 based on the detection of the arrival of the pulse wave in local plethysmographic signals, contrary to what happens with plethysmographic changes in the torso that require specific algorithms and that are less reliable if applied to the IPG signal measured between extremities.
    25 An optimal implementation of the proposed method would be by means of an apparatus containing: a set of electrodes and other sensors integrated in the body of the apparatus capable of being contacted by the subject, either touching, grasping or holding, arranged so that it is possible to obtain of them the IPG between the two upper extremities or between the two lower extremities; a system of
    30 IPG connected to said electrodes; another system integrated in the apparatus that obtains a heart rate signal from a second sensor placed in a distal area of said upper or lower extremities; the signal processing systems necessary to automatically detect the arrival of the pulse wave to an area proximal to the torso in the IPG signal measured between limbs and the arrival
    35 of the pulse wave in the second sensor placed in a distal zone; the calculation systems necessary to calculate the time interval between said two fiducial points; and that it contained, finally, a communication system of the PTI obtained that is responsible for its representation in a display element or the communication of the measured value to another device.
    The electrodes of the proposed apparatus could be easily integrated, for example, in a mobile phone housing, in a bar of a device for performing exercise or in one of a device for measuring other body parameters, such as weight or body composition by bioimpedance analysis, where the mentioned bars will be grasped with the hands. In the case of the lower extremities, the electrodes could be easily integrated into devices on which the feet rested, such as scales or other mechanical platforms. In all the examples mentioned, the proposed apparatus would allow a fast, comfortable, autonomous and non-invasive measurement of the elastic properties of the arteries detected by the
    15 proposed method.
    The invention described herein has the main advantage that it allows to obtain arterial PTT by measuring only in distal areas of the extremities, which allows said PTI to be measured more quickly, comfortably, autonomously and reliably with respect to those
    20 systems that require the placement of at least one sensor in a proximal area with respect to the heart.
    DESCRIPTION OF THE DRAWINGS
    In order to complement the description that is being made and in order to help a better understanding of the characteristics of the invention, a set of drawings is attached as an integral part of this description, where, for illustrative and non-limiting purposes, it has been represented the next:
    Figure 1 - Shows the diagram of a system capable of obtaining the IPG between the hands and also a distal plethysmographic signal (PPG), and that constitutes the element with which the subject comes into contact in one of the embodiments of the present invention .
    35 Figure 2 - Shows the typical IPG waveform measured between the hands together with the local plethysmographic signals (PPG) measured on the shoulder,
    the elbow, wrist and index finger of the same member.
    Figure 3 - Shows the respective path of the current injected through the body
    5 in a measurement of IPG between hands (iIPGm), in a measurement of IPG between feet
    (iIPGp), and in an ICG measurement (iICG), the latter obtained by injecting current between
    electrodes arranged in the neck and abdomen according to the usual procedure to obtain the ICG.
    10 Figure 4 - Shows the linear regression analysis and the Bland-Altman analysis of 480 pairs of simultaneous measurements of the PTI obtained with the proposed method and of the PTI in the carotid-index finger section, measured with a conventional method, that is, between the signal of a pulse sensor in the proximal zone and that of another sensor in the distal zone.
    Figure 5 - It shows the diagram of a system capable of obtaining the IPG between the feet and also the local IPG on one foot, and which constitutes the element in which the subject comes into contact in another embodiment of the present invention.
    20 Figure 6 - Shows the typical IPG waveform measured between the feet together with the local plethysmographic signals (PPG) measured at the beginning of the femoral artery, knee and ankle of the same member.
    Figure 7 - Shows the diagram of a system capable of obtaining the IPG between the feet and also a BCG, and constituting the element with which the subject comes into contact in another embodiment of the present invention.
    EMBODIMENTS OF THE INVENTION
    In a first embodiment of the invention, shown in Figure 1, the PTT in one arm is measured from a system integrated in a handheld device (1) consisting of two pairs of electrodes (2) in contact with the index and middle fingers of each hand of the subject, and of a PPG sensor (3) in contact with the ring finger of the hand of the arm to be examined.
    The IPG signal between the two upper extremities is obtained from an excitation system (4), which injects a high frequency current that flows from the index finger of one hand to the index finger of the other hand through the extremities upper and upper thorax of the subject, and a system of
    5 analog processing (5) that measures, between the middle finger of one hand and that of the other, the voltage at the excitation frequency and extracting the IPG signal from the pulsatile component of said voltage after having been demodulated
    Next, a digital processing module (6) is responsible for detecting the foot of the
    10 wave of the IPG measured between the two hands, and the foot of the wave of the PPG obtained in the ring finger, and of calculating the time difference between both points, which corresponds to the PTT in the subject's arm. Finally, the communication module
    (7) is responsible for communicating the estimated value of the PTT of the subject through an LCD monitor.
    15 Figure 2 shows the IPG measured between the hands and different local plethysmographic waves measured simultaneously and obtained with a PPG sensor located successively on the shoulder, elbow, wrist and ring finger. You can see how, although the beginning of the rise of the wave of the IPG measured between the hands is
    20 before the rest of the pulse waves obtained with the PPG, the maximum slope section is after the arrival of the pulse wave at the shoulder and elbow, so it follows that the traditional algorithms, based on detection of this section, when applied to the IPG measured between the two hands they detect plethysmographic changes in areas of the extremities proximal to the torso and not in the aorta or
    25 in the torso.
    To better illustrate the difference between the IPG measured between the IPGm hands, the IPG measured between the IPGp feet, and the ICG, measured between the neck and the abdomen according to the usual procedure, Figure 3 shows in a simplified way the respective path 30 the current injected by each system. Although the path of the current injected by the IPG measured between the ilPGm hands and the path of the current injected by the ICG i1cG coincide in the aortic arc, the rest of both paths is completely different, so the waveform obtained by each The system will be determined by the particularities of the respective path and should not show any other coincidence in principle. Likewise, the path of the injected current
    For the IPG measured between the ilPGp feet and the path of the current injected by ellCG i1cG they coincide only in the abdomen area, so it is expected that the nature of both signals will be completely different except at that point.
    5 To illustrate the correspondence between the PTT obtained with the proposed method and other PTT obtained with customary methods, the PTT obtained with the proposed method (abbreviated PTThf, English hand-to-finger finger) and the PTT have been simultaneously measured. section between the carotid artery and the index finger measured with two tonometers placed on said artery (abbreviated PTTcf, from the English carotid finger).
    10 The detection of the arrival of the pulse wave has been performed with the method of intersecting slopes in both cases. Figure 4 shows the linear regression analysis and the Bland-Altman analysis of 480 pairs of simultaneous PTT measurements, obtained in various subjects under rhythmic respiration in order to induce changes in PTT; the graphs show a good agreement between the
    15 values of both parameters and it can be seen how the arrival of the pulse wave to the IPG measured between upper extremities is 54.7 ms after the arrival of the pulse wave to the carotid artery, so it follows that the plethysmographic changes detected in the IPG signal measured between the two suppressive extremities they correspond to an area of said limbs and not to changes in the aorta
    20 or in the torso.
    In another preferred embodiment of the invention, analogous to the previous one and shown in Figure 5, the PTT on one leg is measured from a system integrated in a domestic scale (8) consisting of two pairs of electrodes (2), an electrode in contact with the anterior part of the plant and another electrode in contact with the heel of each foot of the subject, and from which the IPG between the two lower extremities is obtained by measuring the tension between an electrode of each foot when it injects current between the other electrode of each foot, and the local IPG is also obtained by measuring the voltage between the two electrodes of the same foot of the leg to be examined, as shown
    30 in figure 5.
    Figure 6 shows the IPG measured between the two lower extremities and different local plethysmographic waves measured simultaneously and obtained with a PPG sensor located successively on the hip, knee and ankle. One can observe how, although the beginning of the rise of the IPG wave measured between the feet
    It is simultaneous with the pulse wave obtained with the PPG at the femoral point, the maximum slope section is subsequent to the arrival of the pulse wave at the femoral point and the knee, so it follows that the traditional algorithms, based on the detection of said section, when applied to the IPG measured between the two feet they detect
    5 plethysmographic changes in areas of the lower extremities proximal to the torso andno to changes in the aorta or torso.
    Thus, although the method proposed in this invention cannot measure plethysmographic changes produced exclusively in the aorta or torso, it offers the advantage
    10 to allow the use of algorithms of proven reliability that allow the robust detection of the arrival of the pulse wave at proximal points to the torso, which can be used to obtain the PTT in arteries that are also of interest for a comfortable monitoring and Non-invasive circulatory system properties.
    In another preferred embodiment of the invention, shown in Figure 7, PTT in the aorta is measured from a system integrated in a household scale (8) consisting of two pairs of electrodes (2), a contact electrode with the front part of the sole of the foot and another electrode in contact with the heel of each foot of the subject, from which the IPG between the feet is obtained by injecting current between the two feet and
    20 measuring the tension between them; and of a system to obtain the balistocardiogram (BCG) from one or several force sensors integrated in the platform. Since the initial waves of the BCG, such as wave 1, reflect cardiac ejection, the delay between these waves and the moment of arrival of the pulse wave of the IPG to the lower extremities corresponds to the PTT in the aorta and a stretch of the artery
    25 femoral
    Once the invention has been sufficiently described, it should only be added that it is possible to make modifications in its constitution, materials used, and in the choice of the sensors used to obtain the second distal signal, and of the methods for
    30 identify the arrival of the pulse wave in this signal and in the IPG measured between the two upper limbs or the two lower extremities, without departing from the scope of the invention, defined in the following claims.
    权利要求:
    Claims (17)
    [1]
    1. A method to estimate the pulse transit time (PTT) from measurements obtained exclusively in distal areas of the extremities characterized by
    5 a) a high frequency current or voltage is injected between the two upper extremities or between the two lower extremities, such that at least one electrode is located in a distal zone of each of the two considered extremities;
    b) the voltage is measured at the frequency injected between at least one electrode 10 located in a distal area of each of said two extremities; c) the impedance plethysmogram (lPG) between said two extremities is extracted from the pulsatile component of said voltage drop; d) the arrival of the pulse wave at an area of said two extremities proximal to the torso is detected from the beginning of the pulse wave of the 15 IPG measured between said two extremities for each beat;
    e) a fiducial point is detected in a second pulse wave of the same beat and corresponding to the arrival of the pulse wave to another zone by a sensor placed in a distal area of the upper or lower extremities;
    20 f) the time interval between the start of the pulse wave of the IPG measured between the two extremities and the fiducial point of the second pulse wave for each beat is measured;
    g) a PTT is obtained from the time interval measured between the pulse waves in the two signals obtained.
    A method according to claim 1, characterized in that the second pulse wave is obtained from a local IPG.
    [3]
    3. A method according to claim 1, characterized in that the second pulse wave is obtained from a photoplethysmogram (PPG).
    [4]
    Four. A method according to claim 1, characterized in that the second 30 pulse wave is obtained from an arterial tonometer.
    [5]
    5. A method according to claim 1, characterized in that the first pulse wave is an IPG measured between the two hands and the second pulse wave is an IPG measured between the two feet.
    [6]
    6. A method according to claim 1, characterized in that the second 35 pulse wave is obtained from a balistocardiogram (BCG).
    [7]
    7. A method according to claims 1 to 4, characterized in that the PTT in an arm is estimated from the start of the pulse wave of the IPG measured between the two hands and the start of the pulse wave of a plethysmographic sensor such as the of claims 2, 3 or 4 placed in the hand of said arm.
    A method according to claims 1 to 4, characterized in that the PTT in a leg is estimated from the start of the pulse wave of the IPG measured between the two feet and the start of the pulse wave of a plethysmographic sensor as that of claims 2,3 or 4 placed on the foot of said leg.
    [9]
    9. A method according to claims 1 to 4, characterized in that the
    10 PTT in the aorta and one leg from the start of the pulse wave of the IPG measured between the two hands and the start of the pulse wave of a plethysmographic sensor such as that of claims 2, 3 or 4 placed on the foot of said leg.
    [10]
    10. A method according to claims 1 and 5, characterized in that the
    15 PTT in the aorta and part of the arms and legs from the beginning of the IPG wave measured between the two hands and the beginning of the IPG wave measured between the two feet
    [11 ]
    eleven . A method according to claims 1 and 6, characterized in that the
    PTT in the aorta and part of the legs from the I wave of the BCG and the onset of the pulse wave in the LPG measured between the two feet.
    [12]
    12. A method according to claims 1 and 6, characterized in that the PTT in the aorta and part of the arms is estimated from the start of the pulse wave of the IPG measured between the two hands and the J wave of the BCG.
    [13]
    13. An apparatus capable of automatically estimating PTT in an arterial segment 25 from plethysmographic measurements obtained exclusively in distal areas of the extremities, containing:
    a) a set of electrodes integrated in the superticia of the apparatus apt to be contacted by the subject, either touching, holding or holding them, arranged so that it is possible to obtain from them the
    30 IPG between the two upper extremities or between the two extremities
    inferior; b) a dellPG measurement system connected to said electrodes; c) a system that obtains a second heart rate signal from
    a sensor suitable for being placed in a distal area of the upper or lower extremities;
    d) a signal processing system capable of automatically detecting the moment of arrival of the pulse wave to a zone proximal to the torso from the IPG measured between the extremities and to another zone from the second pulse signal;
    5 e) a calculation system capable of obtaining the time interval between the respective instants of the pulse wave detected with the system in the previous section;
    f) a calculation system capable of obtaining the PTT from said time interval; 10 g) a communication system capable of communicating to a user or another device, the calculated PTT.
    [14]
    14. An apparatus according to claim 13 characterized in that the electrode assembly is integrated in the housing of a mobile phone, tablet or the remote control of a television or other appliance.
    15. An apparatus according to claim 13 characterized in that the electrode assembly is integrated in an exercise device bar.
    [16]
    16. An apparatus according to claim 13 characterized in that the set of electrodes are integrated in a bar of a device that measures body parameters such as weight or body composition.
    20 17. An apparatus according to claim 13 characterized in that the electrode assembly is integrated in a scale.
    [18]
    18. An apparatus according to claims 13 and 14,1 5, 16 or 17 characterized in that the system that obtains a heart rate signal from a sensor placed in a distal area of the upper or lower extremities is
    25 an impedance plethysmograph that detects local volume changes in the area near where the voltage measurement electrodes are.
    [19]
    19. An apparatus according to claims 13 and 14,15, 16 or 17 characterized in that the system that obtains a heart rate signal from a sensor placed in a distal area of the upper or lower extremities is a
    30 photoplethysmograph.
    [20]
    20. An apparatus according to claims 13 and 14, 15, 16 or 17 characterized in that the system that obtains a heart rate signal from a sensor placed in a distal area of the upper or lower extremities is an arterial tonometer.
    An apparatus according to claims 13 and 14,15, 16 or 17 characterized in that
    he system you getaheart rate signaltostart fromasensor
    placed in a distal area of the upper or lower limbs use
    the same electrodes as the impedance plethysmograph obtained by the IPG
    between the extremities
    5 22An apparatus according to claims 13 and 14, 15, 16 or 17 characterized in that
    he system you getaheart rate signaltostart fromasensor
    placed in a distal area of the upper or lower extremities be
    a balistocardiograph in contact with the feet.
    [23]
    2. 3. An apparatus according to claims 13, 18 and 14, 15, 16 or17 characterized
    10 because the impedance plethysmograph detects local volume changes
    in the area near the one where the voltage measurement electrodes are,
    share the electrodes of the system that obtains the IPG between the
    limbs that are located on that of said two limbs where
    you want to detect the local IPG.
    fifteen
    类似技术:
    公开号 | 公开日 | 专利标题
    ES2398542B1|2014-03-05|Method and apparatus for obtaining cardiovascular information on the feet
    US9808168B2|2017-11-07|Method and system for non-invasive measurement of cardiac parameters
    ES2398439B1|2014-03-05|Method and apparatus for obtaining cardiovascular information by measuring between two extremities
    Thomas et al.2014|BioWatch—A wrist watch based signal acquisition system for physiological signals including blood pressure
    Liu et al.2018|Multi-wavelength photoplethysmography enabling continuous blood pressure measurement with compact wearable electronics
    ES2296474A1|2008-04-16|Method for obtaining heart rate, involves measuring changes in electrical impedance between feet due to ejection of blood from heart with each beat, and is implemented by simply standing on surface
    Carek et al.2017|Robust sensing of distal pulse waveforms on a modified weighing scale for ubiquitous pulse transit time measurement
    ES2805300T3|2021-02-11|Device for non-invasive determination of blood pressure
    ES2607721B2|2019-07-04|Method and apparatus for estimating the transit time of the aortic pulse from measured time intervals between fiducial points of the balistocardiogram
    ES2616740B1|2018-03-21|METHOD AND APPARATUS FOR ESTIMATING THE TRANSIT TIME OF THE ARTERIAL PULSE FROM MEASURES OBTAINED IN DISTAL ZONES OF THE EXTREMITIES
    Zaki et al.2016|Cuff-less continuous blood pressure monitoring system using pulse transit time techniques
    Shimazaki et al.2018|Effect of position and fastening belt pressure on the accuracy of PPG-based heart rate sensor
    Mayrovitz et al.2002|Inspiration-induced vascular responses in finger dorsum skin
    ES2656765B1|2019-01-04|Method and apparatus to detect mechanical systolic events from the balistocardiogram
    Park et al.2006|Continuous measurement of systolic blood pressure using the PTT and other parameters
    Selvaraj et al.2018|Feasibility of noninvasive blood pressure measurement using a chest-worn patch sensor
    Heydari et al.2020|Clinical study of a chest‐based cuffless blood pressure monitoring system
    Carek2019|Cuffless blood pressure monitoring technologies based on pulse transit time
    Kawarada et al.1988|Noninvasive measurement of arterial elasticity in various human limbs
    Gómez Clapers2015|Assessment of trends in the cardiovascular system from time interval measurements using physiological signals obtained at the limbs
    Szaj et al.2021|First Evaluation of the PTN-104 Plethysmographic Sensor for Heart Rate Measurement
    Shiraishi et al.2013|Pulse transit time measurement method with artifact tolerance for home healthcare
    Butlin et al.2019|Non-invasive physiological monitoring
    Babiy2017|Care of patients: Vital signs are vital. Vital signs estimation
    Wiegerinck et al.2021|Electrical impedance plethysmography versus tonometry to measure the pulse wave velocity in peripheral arteries in young healthy volunteers: a pilot study
    同族专利:
    公开号 | 公开日
    CN108471969A|2018-08-31|
    ES2616740B1|2018-03-21|
    EP3375361A1|2018-09-19|
    JP2018537167A|2018-12-20|
    EP3375361A4|2019-05-08|
    KR20180081138A|2018-07-13|
    US20180338691A1|2018-11-29|
    JP6637175B2|2020-01-29|
    WO2017081353A1|2017-05-18|
    KR102193284B1|2020-12-23|
    引用文献:
    公开号 | 申请日 | 公开日 | 申请人 | 专利标题
    US7308303B2|2001-11-01|2007-12-11|Advanced Bionics Corporation|Thrombolysis and chronic anticoagulation therapy|
    US6648828B2|2002-03-01|2003-11-18|Ge Medical Systems Information Technologies, Inc.|Continuous, non-invasive technique for measuring blood pressure using impedance plethysmography|
    US8273030B2|2005-12-01|2012-09-25|Atcor Medical Pty Ltd|Method of estimating pulse wave velocity|
    US8233969B2|2006-07-05|2012-07-31|Koninklijke Philips Electronics, N.V.|Wearable monitoring system|
    CN101484068A|2006-07-05|2009-07-15|皇家飞利浦电子股份有限公司|Wearable blood pressure monitoring system|
    CN100560019C|2007-01-26|2009-11-18|香港中文大学|Pulse wave transmission time method is measured the initial calibration device of arteriotony|
    EP2074942B1|2007-12-21|2012-02-01|CSEM Centre Suisse d'Electronique et de Microtechnique SA - Recherche et Développement|Method and apparatus for a continuous non-invasive and non-obstrusive monitoring of blood pressure|
    US20110009754A1|2009-07-08|2011-01-13|Brian Jeffrey Wenzel|Arterial blood pressure monitoring devices, systems and methods using cardiogenic impedance signal|
    ITPI20090099A1|2009-07-31|2011-02-01|Cnr Consiglio Naz Delle Ric Erche|EQUIPMENT FOR MEASURING THE SPEED OF PROPAGATION OF A PRESSORIAL WAVE IN THE ARTERIAL SYSTEM|
    WO2012007423A1|2010-07-16|2012-01-19|Csem Sa|Method and apparatus for the non-invasive measurement of pulse transit times |
    US10349838B2|2010-08-12|2019-07-16|Board Of Trustees Of Michigan State University|Methods and apparatus for determining arterial pulse wave velocity|
    WO2012103296A2|2011-01-27|2012-08-02|The Board Of Trustees Of The Leland Stanford Junior University|Systems and methods for monitoring the circulatory system|
    US20120215117A1|2011-02-23|2012-08-23|Pacesetter, Inc.|Systems and methods for estimating central arterial blood pressure of a patient|
    ES2398439B1|2011-07-29|2014-03-05|Universitat Politècnica De Catalunya|Method and apparatus for obtaining cardiovascular information by measuring between two extremities|
    KR20130123597A|2012-05-03|2013-11-13|삼성전자주식회사|Portable device for measuring blood pressure and method thereof in mobile terminal|
    US10405791B2|2013-03-15|2019-09-10|Yingchang Yang|Method and continuously wearable noninvasive apparatus for automatically detecting a stroke and other abnormal health conditions|
    CN104771159A|2014-01-10|2015-07-15|吉林四环海斯凯尔科技有限公司|Automatic continuous pulse-wave measurement device and blood-pressure measurement method|
    CN104887209A|2015-06-26|2015-09-09|京东方科技集团股份有限公司|Blood pressure measuring method and system|WO2018233625A1|2017-06-21|2018-12-27|Well Being Digital Limited|An apparatus for monitoring the pulse of a person a method thereof|
    法律状态:
    2018-03-21| FG2A| Definitive protection|Ref document number: 2616740 Country of ref document: ES Kind code of ref document: B1 Effective date: 20180321 |
    优先权:
    申请号 | 申请日 | 专利标题
    ES201531645A|ES2616740B1|2015-11-13|2015-11-13|METHOD AND APPARATUS FOR ESTIMATING THE TRANSIT TIME OF THE ARTERIAL PULSE FROM MEASURES OBTAINED IN DISTAL ZONES OF THE EXTREMITIES|ES201531645A| ES2616740B1|2015-11-13|2015-11-13|METHOD AND APPARATUS FOR ESTIMATING THE TRANSIT TIME OF THE ARTERIAL PULSE FROM MEASURES OBTAINED IN DISTAL ZONES OF THE EXTREMITIES|
    KR1020187016916A| KR102193284B1|2015-11-13|2016-11-11|Method and apparatus for estimating arterial pulse delivery time from measurement of distal area of limb|
    US15/775,756| US20180338691A1|2015-11-13|2016-11-11|Method and device for estimating the arterial pulse transit time from measurements in distal areas of the extremities|
    PCT/ES2016/070804| WO2017081353A1|2015-11-13|2016-11-11|Method and device for estimating the transit time of the arterial pulse from measurements obtained in distal zones of the extremities|
    CN201680078234.5A| CN108471969A|2015-11-13|2016-11-11|Pass through the method and apparatus in the Estimation and Measurement arterial pulse propagation time in far-end of limb region|
    EP16863724.7A| EP3375361A4|2015-11-13|2016-11-11|Method and device for estimating the transit time of the arterial pulse from measurements obtained in distal zones of the extremities|
    JP2018524785A| JP6637175B2|2015-11-13|2016-11-11|A method and apparatus for estimating the transit time of a pulse in an artery from measurements of the tips of both hands or feet.|
    [返回顶部]