Determination of a treatment response index
The present invention relates to determining a treatment response index. In order to improve and facilitate hypertension treatment procedures, a device ( 10 ) for determining a treatment response index is provided that comprises a data input ( 12 ), a data processor ( 14 ) and a data output ( 16 ). The data input is configured to receive a value ( 18 ) of at least one first measurement of a physiological parameter of a subject's vasculature under a first condition; and to provide a value ( 20 ) of at least one second measurement of the physiological parameter of the vasculature under a second condition. In the second condition, a pre-determined stimulation is provided, and the first condition is non-stimulated or at least differently stimulated. The data processor is configured to generate a treatment response index. In an example, the data output is configured to provide a classification of the subject into one of at least two groups of subjects, based on the treatment response index.
1 . An apparatus, comprising:
an intravascular catheter or guidewire configured to be positioned within a renal artery of a subject, wherein the intravascular catheter or guidewire comprises a sensor configured to measure a physiological parameter of the renal artery; and
a controller comprising at least one of a processor, an application specific integrated circuit (ASIC), or a field-programmable gate array (FPGA), wherein the controller is configured to:
control the intravascular catheter or guidewire to:
obtain, with the subject under no stimulation or a first stimulation, a first measurement of the physiological parameter for the renal artery while positioned in the renal artery, wherein the no stimulation or the first stimulation is distinct from renal denervation; and
obtain, with the subject under a second stimulation, a second measurement of the physiological parameter for the renal artery while positioned in the renal artery, wherein the second stimulation is distinct from the renal denervation;
determine a ratio for the renal artery using the first measurement and the second measurement;
generate a renal response index for the renal artery based on the ratio; and
provide the renal response index to a display,
wherein the first and second measurements are obtained, the ratio is determined, and the renal response index is generated and provided to the display before the renal denervation is performed.
2 . The apparatus of claim 1 , wherein the physiological parameter comprises pulse wave velocity.
3 . The apparatus of claim 2 , wherein the second stimulation is configured to cause a hemodynamic alteration for the subject such that the renal response index comprises a pulse propagation alteration index.
4 . The apparatus of claim 1 , wherein the physiological parameter comprises vessel impedance.
5 . The apparatus of claim 4 , wherein the second stimulation is configured to cause a hemodynamic alteration for the subject such that the renal response index comprises a vascular impedance alteration index.
6 . The apparatus of claim 1 , wherein the controller is configured to:
determine whether the subject is suitable for the renal denervation based on at least one of the renal response index; and
provide, to the display, an indicator representative of whether the subject is suitable for the renal denervation.
7 . The apparatus of claim 6 , wherein, to determine whether the subject is suitable for the renal denervation, the controller is configured to provide a classification of the subject into one of at least two groups.
8 . The apparatus of claim 6 , wherein, to determine whether the subject is suitable for the renal denervation, the controller is configured to determine if the renal response index is below or above a pre-determined threshold value.
9 . The apparatus of claim 1 , wherein the second stimulation comprises at least one of a physical maneuver, a pharmaceutical stimulation, or an electrical stimulation.
10 . The apparatus of claim 1 , wherein the controller is configured to:
receive, with the subject under no stimulation or the first stimulation, a further first measurement of a further physiological parameter;
receive, with the subject under the second stimulation, a further second measurement of the further physiological parameter; and
generate the renal response index based on the further first measurement and the further second measurement.
11 . The apparatus of claim 1 , further comprising:
the display.
12 . The apparatus of claim 1 , wherein the controller is configured to control providing at least one of the first stimulation or the second stimulation to the subject.
13 . The apparatus of claim 12 , wherein, to control providing at least one of the first stimulation or the second stimulation, the controller is configured to control at least one of providing an electrical stimulation or providing a pharmaceutical stimulation to the subject.
14 . The apparatus of claim 1 , wherein the controller is configured to control providing the renal denervation to the subject.
15 . The apparatus of claim 14 , wherein, to control providing the renal denervation to the subject, the controller is configured to control providing ablation to the subject.
16 . The apparatus of claim 1 ,
wherein controller is configured to:
generate a further renal response index after at least a part of the renal denervation; and
generate a success index is based on the further renal response index and the renal response index.
17 . The apparatus of claim 6 ,
wherein a relatively smaller magnitude of change between the first measurement and the second measurement is configured to indicate that the subject is in sympathetic overdrive and suitable for the renal denervation,
wherein a relatively larger magnitude of change between the first measurement and the second measurement is configured to indicate that the subject is not in the sympathetic overdrive and not suitable for the renal denervation.