System and method for analyzing an impedance course
A system which generates a warning signal in the event of looming pulmonary edema and/or looming decompensation. The system has an impedance detection unit for determining impedance values, which represent a transthoracic impedance course, and an impedance analysis unit ( 78 ), which is connected to the impedance detection unit. The impedance analysis unit ( 78 ) is implemented to determine the degree of modulation for a particular impedance course detected by the impedance detection unit.
1. A system ( 10 ) comprising:
an impedance detection unit ( 76 ) configured to determine impedance values, which represent a transthoracic impedance course;
an impedance analysis unit ( 78 ), which is connected to the impedance detection unit ( 76 );
wherein the impedance analysis unit ( 78 ) is configured to determine a degree of modulation for a particular impedance course detected by the impedance detection unit ( 76 );
wherein the impedance analysis unit ( 78 ) is further configured to
determine a respiration signal (R) from the transthoracic impedance course and to determine an effective value or mean amplitude of the respiration signal as a modulation parameter that represents the degree of modulation or
determine the respiration signal (R) from the transthoracic impedance course and to determine a ratio of the effective value or the mean amplitude of the respiration signal to a mean impedance (M) of the transthoracic impedance course as the modulation parameter that represents the degree of modulation or
determine the respiration signal (R) and a respiration frequency as a frequency of the respiration signal from the transthoracic impedance course and to determine a relation of the effective value of the respiration signal to the respiration frequency as the modulation parameter that represents the degree of modulation
wherein the impedance analysis unit ( 78 ) is further configured to record trends of one or more modulation parameters over a predefined period of time and to determine trend parameters from these trends or to determine a difference to a preceding modulation parameter value as a trend parameter value
wherein the impedance analysis unit ( 78 ) is further configured to
record trends of one or more modulation parameters comprising a first modulation parameter, a second modulation parameter and a third modulation parameter over a predefined period of time and to determine trend parameters from these trends or to
determine a difference to a preceding modulation parameter value as a first trend parameter value, and
determine a first difference between said first modulation parameter and said second modulation parameter wherein said first modulation parameter and said second modulation parameter are two sequential modulation parameters and
determine a second difference between said second modulation parameter and said third modulation parameter wherein said second modulation parameter and said third modulation parameter are also two sequential modulation parameters
and
compare said first difference to said second difference as a second trend parameter value; and,
wherein the impedance analysis unit ( 78 ) is coupled with a first threshold comparator ( 108 ) and a second threshold comparator ( 112 ) which are respectively configured to compare the first trend parameter value to a first threshold value and compare the second trend parameter value to a second threshold value and to generate a warning signal as a function of whether a respective first and second trend parameter values exceed or fall below the respective first and second threshold value.
2. The system according to claim 1 , wherein the impedance analysis unit ( 78 ) is implemented to determine circadian oscillations or changes of the circadian oscillations of the one or more modulation parameters as the trend parameter value.
3. The system according to claim 1 , wherein the impedance analysis unit ( 78 ) is implemented to determine the respiration signal (R) and the respiration frequency as the frequency of the respiration signal from the transthoracic impedance course and to determine a change of a relation between amplitude of the respiration signal and the frequency of the respiration signal as the trend parameter value.
4. The system according to claim 1 , wherein the impedance analysis unit ( 78 ) is implemented to average cyclically measured impedance values over a predefined period of time and to determine a mean impedance (M) from the cyclically measured impedance values as averaged, and to determine a circadian signal from the mean impedance.
5. The system according to claim 4 , wherein the impedance analysis unit ( 78 ) is implemented to determine, from the circadian signal, at least one circadian parameter which characterizes the circadian signal.
6. The system according to claim 5 , wherein the impedance analysis unit ( 78 ) is implemented to
determine a particular maximum daily oscillation of the transthoracic impedance course as a difference between maximum and minimum impedance values of a day as the at least one circadian parameter or
determine a daily mean value of the transthoracic impedance course and to determine a ratio of a duration of a first half period, during which the transthoracic impedance course runs above the daily mean value, to a duration of a second half period, during which the transthoracic impedance course runs below the daily mean value, as the at least one circadian parameter.
7. The system according to claim 5 , wherein the impedance analysis unit ( 78 ) is implemented to
determine a phase of a circadian oscillation of the transthoracic impedance course in relation to a daily time curve as the at least one circadian parameter or
determine a time of day of a maximum and/or minimum of the transthoracic impedance course as the phase of the circadian oscillation of the transthoracic impedance course or
determine a difference of impedance values of two constant daily points in time or also a day/night difference as the at least one circadian parameter.
8. The system according to claim 1 , wherein the impedance analysis unit ( 78 ) is implemented to
link a circadian parameter or a trend of the circadian parameter to a trend of a modulation parameter of the respiration signal or the modulation parameter itself, or
determine a phase shift between a circadian signal and a circadian trend of a respiration signal parameter, or
evaluate a correlation between one or more parameters of the circadian signal and parameters of the respiration signal and to derive a degree of a decompensation therefrom.
9. The system according to claim 1 , wherein the system is integrated in an implant ( 10 ), which comprises both the impedance detection unit ( 76 ) and also the impedance analysis unit ( 78 ).
10. The implant ( 10 ) according to claim 9 , wherein the implant ( 10 ) is a cardiac pacemaker or cardioverter/defibrillator.
11. The system according to claim 1 , wherein the system comprises an implant ( 10 ) having a telemetry unit ( 58 ) and an external device ( 120 ; 130 ), which may receive data that represents the impedance values telemetrically from a side of the implant ( 10 ), the impedance detection unit ( 76 ) being a component of the implant ( 10 ) and the impedance analysis unit ( 78 ) being a component of the external device ( 120 ).
12. The system according to claim 1 , wherein the system comprises an implant ( 10 ) having a telemetry unit ( 58 ) and a service center ( 130 ), which is to be connected at least indirectly connected to the telemetry unit ( 58 ) of the implant ( 10 ) in order to receive data that represents the impedance values from a side of the implant ( 10 ), wherein the impedance detection unit ( 76 ) is a component of the implant ( 10 ) and wherein the impedance analysis unit ( 78 ) is a component of the service center ( 130 ).