Pressure based structural heart assessment systems and methods
The heart valve assessment systems described herein advantageously provide indicators of a heart valve condition, such as a pressure gradient or a valve regurgitation index. The heart valve assessment systems can provide indicators of a heart valve condition during a heart procedure. A pressure gradient indicates a severity or measurement of the narrowing (or stenosis) of a valve by the increase in pressure behind it. A valve regurgitation index indicates a leakiness measurement of a valve.
1 . A system comprising:
a pressure guidewire comprising:
an outer tube,
a core wire, and
a first pressure sensor, wherein the first pressure sensor is positioned radially between a reduced diameter portion of the core wire and a coil portion of the outer tube;
a second pressure sensing device comprising a second pressure sensor;
a non-transitory computer storage medium configured to at least store computer-executable instructions; and
one or more hardware processors in communication with the non-transitory computer storage medium, the one or more hardware processors configured to execute the computer-executable instructions to at least:
calibrate the second pressure sensor relative to the first pressure sensor while (i) the first pressure sensor is positioned in a first portion of a heart and (ii) the second pressure sensor is positioned in a cardiovascular region adjacent to the first portion of the heart, wherein to calibrate the second pressure sensor relative to the first pressure sensor further comprises:
determine a first plurality of pressure values from the first pressure sensor positioned in the first portion of the heart;
determine a second plurality of pressure values from the second pressure sensor in the cardiovascular region adjacent to the first portion of the heart;
detect a dicrotic notch feature in the first plurality of pressure values;
identify a timestamp corresponding to the dicrotic notch feature;
determine, from the first plurality of pressure values, a first value at the timestamp;
determine, from the second plurality of pressure values, a second value at the timestamp; and
determine a gain adjustment based at least in part on the first value and the second value;
determine a third plurality of pressure values from the first pressure sensor positioned in the first portion of the heart;
determine a fourth plurality of pressure values from the second pressure sensor positioned in the cardiovascular region adjacent to the first portion of the heart, wherein to determine the fourth plurality of pressure values further comprises:
apply the gain adjustment to an initial plurality of pressure values from the second pressure sensor;
detect a first feature in the third plurality of pressure values;
detect a second feature in the fourth plurality of pressure values;
determine a heart valve condition based at least in part on the first feature and the second feature; and
display the heart valve condition on a user interface.
2 . The system of claim 1 , wherein to calibrate the second pressure sensor relative to the first pressure sensor further comprises:
a detect a value at a substantially beginning of a systolic phase in the first plurality of pressure values;
determine a time adjustment to the second plurality of pressure values such that a value from the second plurality of pressure values corresponds to the value at the substantially beginning of the systolic phase in the first plurality of pressure values, wherein to apply the gain adjustment further comprises:
apply the time adjustment and the gain adjustment to the initial plurality of pressure values.
3 . The system of claim 1 , wherein to identify the timestamp corresponding to the dicrotic notch feature further comprises:
identify the timestamp within a percentage of a heartbeat period before or after the dicrotic notch feature in the first plurality of pressure values.
4 . The system of claim 1 , wherein the first value corresponds to V 1 , the second value corresponds to V 2 , the gain adjustment comprises g, and wherein to determine the gain adjustment further comprises a determining relationship substantially as:
g=V 1 /V 2 .
5 . The system of claim 1 , wherein the first feature comprises at least one of a systolic phase or a diastolic phase in the third plurality of pressure values.
6 . A system comprising:
a pressure guidewire comprising:
an outer tube,
a connector tube positioned radially inward of the outer tube,
a core wire positioned radially inward of the outer tube, and
a pressure sensor assembly comprising a first pressure sensor and a pressure wire lead extending from the first pressure sensor toward a proximal end of the pressure guidewire, the first pressure sensor being distal of a distal end of the connector tube;
a second pressure sensing device comprising a second pressure sensor; and
one or more hardware processors configured to at least:
calibrate one of the first pressure sensor or the second pressure sensor relative to the other one of the first pressure sensor or the second pressure sensor while (i) the first pressure sensor is positioned in a first portion of a heart and (ii) the second pressure sensor is positioned in a cardiovascular region adjacent to the first portion of the heart, wherein to calibrate the second pressure sensor relative to the first pressure sensor further comprises:
determine a first plurality of pressure values from one of the first pressure sensor or the second pressure sensor;
determine a second plurality of pressure values from the other one of the first pressure sensor or the second pressure sensor;
detect a first dicrotic notch feature in the first plurality of pressure values;
identify a timestamp corresponding to the dicrotic notch feature;
determine, from the first plurality of pressure values, a first value at the timestamp;
determine, from the second plurality of pressure values, a second value at the timestamp; and
determine a gain adjustment based at least in part on the first value and the second value;
determine a third plurality of pressure values from one of the first pressure sensor or the second pressure sensor;
determine a fourth plurality of pressure values from the other one of the first pressure sensor or the second pressure sensor, wherein to determine the fourth plurality of pressure values further comprises:
apply the gain adjustment to an initial plurality of pressure values from the other one of the first pressure sensor or the second pressure sensor;
detect a first feature in the third plurality of pressure values;
detect a second feature in the fourth plurality of pressure values;
determine a heart valve condition based at least in part on the first feature and the second feature; and
display the heart valve condition on a user interface.
7 . The system of claim 6 , wherein to calibrate one of the first pressure sensor or the second pressure sensor further comprises:
detect a value at a substantially beginning of a systolic phase in the first plurality of pressure values;
determine a time adjustment to the second plurality of pressure values such that a value from the second plurality of pressure values corresponds to the value at the substantially beginning of the systolic phase in the first plurality of pressure values, wherein to apply the gain adjustment further comprises:
apply the time adjustment and the gain adjustment to the initial plurality of pressure values.
8 . The system of claim 6 , wherein to identify the timestamp corresponding to the first dicrotic notch feature further comprises:
identify the timestamp within a percentage of a heartbeat period before or after the first dicrotic notch feature in the first plurality of pressure values.
9 . The system of claim 6 , wherein the first value corresponds to V 1 , the second value corresponds to V 2 , the gain adjustment comprises g, and wherein to determine the gain adjustment further comprises a determining relationship substantially as:
g=V 1 /V 2 .
10 . The system of claim 6 , wherein the first feature comprises at least one of a systolic phase or a first diastolic phase in the third plurality of pressure values.
11 . The system of claim 6 , wherein to detect the first dicrotic notch feature further comprises:
calculate a plurality of second derivative values from the first plurality of pressure values; and
identify a point of zero crossing based at least in part on the plurality of second derivative values, wherein the point of zero crossing corresponds to the first dicrotic notch feature.
12 . The system of claim 6 , wherein to detect the first dicrotic notch feature further comprises:
calculate, from the first plurality of pressure values, a first angle for a first point based at least in part on a first preceding point and a first following point;
calculate, from the first plurality of pressure values, a second angle for a second point based at least in part on a second preceding point and a second following point;
determine that the second angle is less than the first angle; and
identify the second point as the first dicrotic notch feature.
13 . The system of claim 6 , wherein the first feature comprises at least one of a systolic phase or a diastolic phase in the third plurality of pressure values, wherein to detect the at least one of the systolic phase or the diastolic phase further comprises:
identify a first subset of rising pressure values from the third plurality of pressure values;
identify a local minimum pressure value from the third plurality of pressure values;
determine a tangent from the first subset;
identify a horizontal line intersecting the local minimum pressure value;
identify a first intersection between the tangent and the horizontal line; and
identify a first point from the third plurality of pressure values as an end of the diastolic phase or a beginning of the first systolic phase based at least in part on the first intersection.