Method And System For Determining Myocardial Ischemia Severity Based On Hemodynamic Parameters Estimation
Abstract:
This disclosure relates generally to method and system for determining myocardial ischemia severity based on hemodynamic parameters estimation. Many patients suffer from myocardial ischemia due to narrowing of coronary artery resulting poor oxygen supply in cardiac muscles. The method includes receiving Electrophysiology (EP) signal from a simulated heart surface model to generate a single lead ECG template. The method further estimates hemodynamic parameters using a hemodynamic module based on the single lead ECG template and then estimates cardiac pressure-volume loop variables. The myocardial ischemia severity of the heart surface model is determined which includes one of moderate ischemia, severe ischemia and silent ischemia. Here, the cardiac source module is coupled with the hemodynamic module to determine cardiac transmembrane potential (TMP) of the heart surface model through contractility function. This method serves as a guidance platform for patient care such as synthetic data generation for disease classification pertaining to coronary artery.
Get Free WhatsApp Updates!
Notices, Deadlines & Correspondence
Nirmal Building, 9th
Floor, Nariman
Point, Mumbai
400021,
Maharashtra, India
Inventors
1. MAZUMDER, Oishee
Tata Consultancy Services Limited, Block -1B, Eco Space, Plot No. IIF/12 (Old No. AA-II/BLK 3. I.T) Street 59 M. WIDE (R.O.W.) Road, New Town, Rajarhat, P.S. Rajarhat, Dist - N. 24 Parganas, Kolkata - 700160, West Bengal, India
2. ROY, Dibyendu
Tata Consultancy Services Limited, Block -1B, Eco Space, Plot No. IIF/12 (Old No. AA-II/BLK 3. I.T) Street 59 M. WIDE (R.O.W.) Road, New Town, Rajarhat, P.S. Rajarhat, Dist - N. 24 Parganas, Kolkata - 700160, West Bengal, India
3. SINHA, Aniruddha
Tata Consultancy Services Limited, Block -1B, Eco Space, Plot No. IIF/12 (Old No. AA-II/BLK 3. I.T) Street 59 M. WIDE (R.O.W.) Road, New Town, Rajarhat, P.S. Rajarhat, Dist - N. 24 Parganas, Kolkata - 700160, West Bengal, India
Specification
Claims:
A processor implemented method for determining myocardial ischemia severity based on hemodynamic parameters estimation, the method comprising:
receiving (302), via one or more hardware processors (104), a plurality of Electrophysiology (EP) signals from a heart surface model as an input, wherein each Electrophysiology (EP) signal from the plurality of Electrophysiology (EP) signals corresponds to cardiac transmembrane potential (TMP) giving rise to cardiac contraction;
generating (304), via the one or more hardware processors (104), by a cardiac source module, a Forward Electrophysiology signal from the plurality of Electrophysiology (EP) signals;
processing (306), via the one or more hardware processors (104), the Forward Electrophysiology signal, to generate a single lead ECG template, wherein the single lead ECG template comprises at least one of a parameter comprising: (i) a auricular depolarization (PQ) segment, (ii) a ventricular depolarization (QRS) segment, (iii) a ventricular repolarization (ST) segment and combination thereof;
estimating (308), via the one or more hardware processors (104), by a hemodynamic module, a plurality of hemodynamic parameters based on the single lead ECG template, wherein the plurality of hemodynamic parameters comprises a left heart atrium compliance function C_la (t) and a left heart ventricle compliance function C_lv (t);
estimating (310), via the one or more hardware processors (104), a plurality of cardiac pressure-volume loop variables based on at least one of (i) the plurality of hemodynamic parameters, and (ii) pressure variation associated with cardiac excitation; and
determining (312), via the one or more hardware processors (104), myocardial ischemia severity of the heart surface model based on at least one of (i) a scar tissue size, (ii) a velocity reduction value of the cardiac affected region, (iii) a transmembrane potential (TMP) amplitude and repolarization time, (iv) the single lead ECG template and (v) the plurality of cardiac pressure-volume loop variables, wherein the myocardial ischemia severity includes one of moderate ischemia, severe ischemia and silent ischemia.
The method as claimed in claim 1, wherein the cardiac transmembrane potential (TMP) of the heart surface model is determined through contractility function which is based on coupling of the cardiac source module with the hemodynamic module.
The method as claimed in claim 1, wherein the left heart atrium compliance function C_la (t) is computed based on at least one of (i) a minimum value of the left heart atrium, (ii) a maximum value of the left heart atrium, (iii) a left heart atrium activation function (A_la), and (iv) a time delay in firing between the left heart atrium and the left heart ventricle.
The method as claimed in claim 3, wherein the left heart atrium activation function (A_la) is computed based on left heart atrium activation time analogous to the auricular depolarization (PQ) segment and the time duration of the cardiac cycle.
The method as claimed in claim 1, wherein the left heart ventricle compliance function C_lv (t) is computed based on an end systolic compliance and the left heart ventricle activation function (A_lv (t)).
The method as claimed in claim 5, wherein the left heart ventricle activation function (A_lv (t)) is computed based on systolic and diastolic time duration of the cardiac cycle analogous to (i) the ventricular depolarization (QRS) segment, and (ii) the ventricular repolarization (ST) segment.
The method as claimed in claim 1, wherein the plurality of cardiac pressure-volume loop variables includes at least one of (i) a dynamic change observed in a systemic artery pressure, (ii) a dynamic change observed in a left heart ventricle pressure and (iii) a dynamic change observed in a right ventricle pressure.
The method as claimed in claim 7, wherein the dynamic change observed in the systemic artery pressure is estimated based on at least one of (i) a systemic artery compliance, (ii) the left heart ventricle pressure, (iii) a systemic ventricle pressure, (iv) a systemic artery pressure,(v) a resistance value observed in systemic vessels, and (vi) a resistance value observed in aortic vessel.
The method as claimed in claim 7, wherein the dynamic change observed in the left heart ventricle pressure is estimated based on at least one of (i) the left heart ventricle compliance function, (ii) the left heart ventricle pressure, (iii) a pulmonary vein pressure, (iv) the systemic artery pressure, (v) a resistance value observed in mitral vessel, and (vi) a resistance value observed in aortic vessel.
The method as claimed in claim 7, wherein the dynamic change observed in the right heart ventricle pressure is estimated based on at least one of (i) the right heart ventricle compliance function, (ii) a systemic vein pressure, (iii) the right heart ventricle pressure, (iv) a resistance value observed in tricuspid vessel, (v) a pulmonary artery pressure, and (vi) a resistance value observed in pulmonary valve.
The method as claimed in claim 1, wherein the moderate myocardial ischemia is determined if (i) the scar tissue size varies between a first threshold value and a second threshold value, (ii) the velocity reduction value of cardiac affected region is equal to a velocity value, and (iii) the cardiac transmembrane potential (TMP) amplitude and repolarization time range between a first repolarization time value and a second repolarization time value.
The method as claimed in claim 1, wherein the severe myocardial ischemia is determined if (i) the scar tissue size varies between a first predetermined value and a second predetermined value, (ii) the velocity reduction value of cardiac affected region is equal to a velocity value, and (iii) the cardiac transmembrane potential (TMP) amplitude and repolarization time range between a first transmembrane potential amplitude value and a second transmembrane potential amplitude value.
The method as claimed in claim 1, wherein the silent myocardial ischemia is determined if (i) the scar tissue size varies between a first predefined value and a second predefined value, (ii) the velocity reduction value of cardiac affected region is equal to a velocity value, and (iii) the cardiac transmembrane potential (TMP) amplitude and repolarization time range between a first transmembrane potential value and a second transmembrane potential value.
A system (100), for determining myocardial ischemia severity based on hemodynamic parameters estimation, the system comprises:
a memory (102) storing instructions;
one or more communication interfaces (106); and
one or more hardware processors (104) coupled to the memory (102) via the one or more communication interfaces (106), wherein the one or more hardware processors (104) are configured by the instructions to:
receive, a plurality of Electrophysiology (EP) signals from a heart surface model as an input, wherein each Electrophysiology (EP) signal from the plurality of Electrophysiology (EP) signals corresponds to cardiac transmembrane potential (TMP) giving rise to cardiac contraction;
generate, by a cardiac source module, a Forward Electrophysiology signal from the plurality of Electrophysiology (EP) signals;
process, the Forward Electrophysiology signal, to generate a single lead ECG template, wherein the single lead ECG template comprises at least one of a parameter comprising: (i) a auricular depolarization (PQ) segment, (ii) a ventricular depolarization (QRS) segment, (iii) a ventricular repolarization (ST) segment and combination thereof;
estimate, by a hemodynamic module, a plurality of hemodynamic parameters based on the single lead ECG template, wherein the plurality of hemodynamic parameters comprises a left heart atrium compliance function C_la (t) and a left heart ventricle compliance function C_lv (t);
estimate, a plurality of cardiac pressure-volume loop variables based on atleast one of (i) the plurality of hemodynamic parameters, and (ii) pressure variation associated with cardiac excitation; and
determine, myocardial ischemia severity of the heart surface model based on at least one of (i) a scar tissue size, (ii) a velocity reduction value of the cardiac affected region, (iii) the transmembrane potential (TMP) amplitude and repolarization time, (iv) the single lead ECG template and (v) the plurality of cardiac pressure-volume loop variables, wherein the myocardial ischemia severity includes one of moderate ischemia, severe ischemia and silent ischemia.
The system (100) as claimed in claim 14, wherein the cardiac transmembrane potential (TMP) of the heart surface model is determined through contractility function which is based on coupling of the cardiac source module with the hemodynamic module.
The system (100) as claimed in claim 14, wherein the left heart atrium compliance function C_la (t) is computed based on atleast one of (i) a minimum value of the left heart atrium, (ii) a maximum value of the left heart atrium, (iii) a left heart atrium activation function (A_la), and (iv) a time delay in firing between the left heart atrium and the left heart ventricle, wherein the left heart atrium activation function (A_la) is computed based on left heart atrium activation time analogous to the auricular depolarization (PQ) segment and the time duration of the cardiac cycle.
The system (100) as claimed in claim 14, wherein the left heart ventricle compliance function C_lv (t) is computed based on the end systolic compliance and the left heart ventricle activation function (A_lv (t)), wherein the left heart ventricle activation function (A_lv (t)) is computed based on an systolic and diastolic time duration of the cardiac cycle analogous to (i) the ventricular depolarization (QRS) segment, and (ii) the ventricular repolarization (ST) segment.
The system (100) as claimed in claim 14, wherein the plurality of cardiac pressure-volume loop variables includes at least one of (i) a dynamic change observed in a systemic artery pressure, (ii) a dynamic change observed in a left heart ventricle pressure and (iii) a dynamic change observed in a right ventricle pressure.
The system (100) as claimed in claim 14, wherein the dynamic change observed in the systemic artery pressure is estimated based on at least one of (i) a systemic artery compliance, (ii) the left heart ventricle pressure, (iii) a systemic ventricle pressure, (iv) a systemic artery pressure,(v)a resistance value observed in systemic vessels, and (vi) a resistance value observed in aortic vessel.
The system (100) as claimed in claim 19, wherein the dynamic change observed in the left heart ventricle pressure is estimated based on at least one of (i) the left heart ventricle compliance function, (ii) the left heart ventricle pressure, (iii) a pulmonary vein pressure, (iv) the systemic artery pressure, (v) a resistance value observed in mitral vessel, and (vi) the resistance value observed in aortic vessel.
, Description:FORM 2
THE PATENTS ACT, 1970
(39 of 1970)
&
THE PATENT RULES, 2003
COMPLETE SPECIFICATION
(See Section 10 and Rule 13)
Title of invention:
METHOD AND SYSTEM FOR DETERMINING MYOCARDIAL ISCHEMIA SEVERITY BASED ON HEMODYNAMIC PARAMETERS ESTIMATION
Applicant:
Tata Consultancy Services Limited
A company Incorporated in India under the Companies Act, 1956
Having address:
Nirmal Building, 9th Floor,
Nariman Point, Mumbai 40001,
Maharashtra, India
The following specification particularly describes the invention and the manner in which it is to be performed.
TECHNICAL FIELD
The disclosure herein generally relates to myocardial ischemia disease, and, more particularly, to method and system for determining myocardial ischemia severity based on hemodynamic parameters estimation.
BACKGROUND
Myocardial ischemia leads to sudden cardiac death due to narrowing of coronary artery causing poor oxygen deprivation in cardiac muscles. Many patients suffer from myocardial ischemia due to smoking, diabetes, hypertension, and the like. Early detection of myocardial ischemia provides opportunity for a wide range of effective therapies such as surgical revascularization, neural stimulation, and drug delivery to reduce cardiac workload or to improve cardiac circulation. In recent years, computer simulations and mathematical models have provided substantial insights for electrophysiological behavior to detect abnormalities in myocardial ischemia. Varying ischemia conditions in cardiac contractility results inefficient pumping in heart muscles and thus hampers hemodynamic equilibrium. Further, any computer models to determine ischemic progression provides dual effect of change in electrophysiology and hemodynamics as the disease manifests. Concurrently, there have been numerous researches to unravel the progression and manifestation of acute ischemia, but the complexity of induced changes in ischemia have inaccurate evaluation and alteration of cardiac properties with progression of the disease. In such scenarios, a scalable and performance efficient technique is necessary for assessing the progression of myocardial ischemia by observing the change in disease severity.
Conventionally, myocardial ischemia has been detected by analyzing the recorded electrocardiogram (ECG) signals from the body surface using amplifiers and associated instrumentation. To monitor patients for ischemia and myocardial infarction, physicians rely upon periodic ECG signals which generally require as many as ten leads to be attached to the patient. In addition, physicians generally require the patient to take a stress test wherein the patient perform activity such as walking/running on a treadmill until the patient is essentially exhausted to stress the heart. Such methods may lack ability to efficiently deal with large numbers of mixed scenarios due to varying change in cardiac contractility. Also, several open source platforms enabled computer simulations and mathematical models to determine ischemic progression such as SCIRun problem solving environment. These open source platforms lack in the fact that they process only the underlying electrophysiology signals, neglecting the effect of ischemic progression in cardiac hemodynamic.
SUMMARY
Embodiments of the present disclosure present technological improvements as solutions to one or more of the above-mentioned technical problems recognized by the inventors in conventional systems. For example, in one embodiment, a method for determining myocardial ischemia severity based on hemodynamic parameter estimation is provided. The system includes for determining myocardial ischemia severity based on hemodynamic parameter estimation is provided. The method includes receiving a plurality of Electrophysiology (EP) signals from a heart surface model as an input. Each Electrophysiology (EP) signal from the plurality of Electrophysiology (EP) signals corresponds to cardiac transmembrane potential (TMP) giving rise to cardiac contraction. Further, a Forward Electrophysiology signal from the plurality of Electrophysiology (EP) signals is generated by a cardiac source module. Further, the Forward Electrophysiology signal are processed to generate a single lead ECG template, wherein the single lead ECG template comprises at least one parameter comprising: (i) a auricular depolarization (PQ) segment, (ii) a ventricular depolarization (QRS) segment, (iii) a ventricular repolarization (ST) segment and combination thereof. Further, using a hemodynamic module, a plurality of hemodynamic parameters based on the single lead ECG template is estimated. The plurality of hemodynamic parameters comprises a left heart atrium compliance function C_la (t) and a left heart ventricle compliance function C_lv (t). Then, a plurality of cardiac pressure-volume loop variables is estimated based on atleast one of (i) the plurality of hemodynamic parameters, and (ii) pressure variation associated with cardiac excitation. Furthermore, myocardial ischemia severity of the heart surface model is determined based on at least one of (i) a scar tissue size, (ii) a velocity reduction value of the cardiac affected region, (iii) the transmembrane potential (TMP) amplitude and repolarization time, (iv) the single lead ECG template and (v) the plurality of cardiac pressure-volume loop variables. The myocardial ischemia severity includes one of moderate ischemia, severe ischemia and silent ischemia.
Further, the system of the cardiac source module is coupled with the hemodynamic module to determine cardiac transmembrane potential (TMP) of the heart surface model through a contractility function. The left heart atrium compliance function C_la (t) is computed based on atleast one of (i) a minimum value of the left heart atrium, (ii) a maximum value of the left heart atrium, (iii) a left heart atrium activation function (A_la), and (iv) a time delay in firing between the left heart atrium and the left heart ventricle. Further, the left heart atrium activation function (A_la) is computed based on left heart atrium activation time analogous to the auricular depolarization (PQ) segment and the time duration of the cardiac cycle. The left heart ventricle compliance function C_lv (t) is computed based on the end systolic compliance and the left heart ventricle activation function (A_lv (t)). The left heart ventricle activation function (A_lv (t)) is computed based on an end systolic and diastolic time duration of the cardiac cycle analogous to (i) the ventricular depolarization (QRS) segment, and (ii) the ventricular repolarization (ST) segment. The plurality of cardiac pressure-volume loop variables includes at least one of (i) a dynamic change observed in a systemic artery pressure, (ii) a dynamic change observed in a left heart ventricle pressure and (iii) a dynamic change observed in a right ventricle pressure. Further, the dynamic change observed in the systemic artery pressure is estimated based on at least one of (i) a systemic artery compliance, (ii) the left heart ventricle pressure, (iii) a systemic ventricle pressure, (iv) a systemic artery pressure,(v)a resistance value observed in systemic vessels, and (vi) a resistance value observed in aortic vessel. The dynamic change observed in the left heart ventricle pressure is estimated based on at least one of (i) the left heart ventricle compliance function, (ii) the left heart ventricle pressure, (iii) a pulmonary vein pressure, (iv) the systemic artery pressure, (v) a resistance value observed in mitral vessel, and (vi) the resistance value observed in aortic vessel. The dynamic change observed in the right heart ventricle pressure is estimated based on at least one of (i) the right heart ventricle compliance function, (ii) a systemic vein pressure (iii) the right heart ventricle pressure, (iv) a resistance value observed in tricuspid vessel, (v) a pulmonary artery pressure, and (vi) a resistance value observed in pulmonary valve.
The moderate myocardial ischemia is determined if (i) the scar tissue size varies between a first threshold value and a second threshold value, (ii) the velocity reduction value of cardiac affected region is equal to a velocity value, and (iii) the cardiac transmembrane potential (TMP) amplitude and repolarization time range between a first repolarization time value and a second repolarization time value. The severe myocardial ischemia is determined if (i) the scar tissue size varies between a first predetermined value and a second predetermined value, (ii) the velocity reduction value of cardiac affected region is equal to a velocity value, and (iii) the cardiac transmembrane potential (TMP) amplitude and repolarization time range between a first transmembrane potential amplitude value and a second transmembrane potential amplitude value. The silent myocardial ischemia is determined if (i) the scar tissue size varies between a first predefined value and a second predefined value, (ii) the velocity reduction value of cardiac affected region is equal to a velocity value, and (iii) the cardiac transmembrane potential (TMP) amplitude and repolarization time range between a first transmembrane potential value and a second transmembrane potential value.
In another aspect, a method for determining myocardial ischemia severity based on hemodynamic parameter estimation is provided. The method includes receiving a plurality of Electrophysiology (EP) signals from a heart surface model as an input. Each Electrophysiology (EP) signal from the plurality of Electrophysiology (EP) signals corresponds to cardiac transmembrane potential (TMP) giving rise to cardiac contraction. Further, a Forward Electrophysiology signal from the plurality of Electrophysiology (EP) signals is generated by a cardiac source module. Further, the Forward Electrophysiology signal are processed to generate a single lead ECG template, wherein the single lead ECG template comprises at least one parameter comprising: (i) a auricular depolarization (PQ) segment, (ii) a ventricular depolarization (QRS) segment, (iii) a ventricular repolarization (ST) segment and combination thereof. Further, using a hemodynamic module, a plurality of hemodynamic parameters based on the single lead ECG template is estimated. The plurality of hemodynamic parameters comprises a left heart atrium compliance function C_la (t) and a left heart ventricle compliance function C_lv (t). Then, a plurality of cardiac pressure-volume loop variables is estimated based on atleast one of (i) the plurality of hemodynamic parameters, and (ii) pressure variation associated with cardiac excitation. Furthermore, myocardial ischemia severity of the heart surface model is determined based on at least one of (i) a scar tissue size, (ii) a velocity reduction value of the cardiac affected region, (iii) the transmembrane potential (TMP) amplitude and repolarization time, (iv) the single lead ECG template and (v) the plurality of cardiac pressure-volume loop variables. The myocardial ischemia severity includes one of moderate ischemia, severe ischemia and silent ischemia.
Further, the method of the cardiac source module is coupled with the hemodynamic module to determine cardiac transmembrane potential (TMP) of the heart surface model through contractility function. The left heart atrium compliance function C_la (t) is computed based on atleast one of (i) a minimum value of the left heart atrium, (ii) a maximum value of the left heart atrium, (iii) a left heart atrium activation function (A_la), and (iv) a time delay in firing between the left heart atrium and the left heart ventricle. Further, the left heart atrium activation function (A_la) is computed based on the left heart atrium activation time analogous to the auricular depolarization (PQ) segment and the time duration of the cardiac cycle. The left heart ventricle compliance function C_lv (t) is computed based on the end systolic compliance and the left heart ventricle activation function (A_lv (t)). The left heart ventricle activation function (A_lv (t)) is computed based on systolic and diastolic time duration of the cardiac cycle analogous to (i) the ventricular depolarization (QRS) segment, and (ii) the ventricular repolarization (ST) segment. The plurality of cardiac pressure-volume loop variables includes at least one of (i) a dynamic change observed in a systemic artery pressure, (ii) a dynamic change observed in a left heart ventricle pressure and (iii) a dynamic change observed in a right ventricle pressure. . Further, the dynamic change observed in the systemic artery pressure is estimated based on at least one of (i) left heart ventricle pressure is estimated based on at least one of (i) the left heart ventricle compliance function, (ii) the left heart ventricle pressure, (iii) a pulmonary vein pressure, (iv) the systemic artery pressure, (v) a resistance value observed in mitral vessel, and (vi) the resistance value observed in aortic vessel. The dynamic change observed in the right heart ventricle pressure is estimated based on at least one of (i) the right heart ventricle compliance function, (ii) a systemic vein pressure (iii) the right heart ventricle pressure, (iv) a resistance value observed in tricuspid vessel, (v) a pulmonary artery pressure, and (vi) a resistance value observed in pulmonary valve.
The moderate myocardial ischemia is determined if (i) the scar tissue size varies between a first threshold value and a second threshold value, (ii) the velocity reduction value of cardiac affected region is equal to a velocity value, and (iii) the cardiac transmembrane potential (TMP) amplitude and repolarization time range between a first repolarization time value and a second repolarization time value. The severe myocardial ischemia is determined if (i) the scar tissue size varies between a first predetermined value and a second predetermined value, (ii) the velocity reduction value of cardiac affected region is equal to a velocity value, and (iii) the cardiac transmembrane potential (TMP) amplitude and repolarization time range between a first transmembrane potential amplitude value and a second transmembrane potential amplitude value. The silent myocardial ischemia is determined if (i) the scar tissue size varies between a first predefined value and a second predefined value, (ii) the velocity reduction value of cardiac affected region is equal to a velocity value, and (iii) the cardiac transmembrane potential (TMP) amplitude and repolarization time range between a first transmembrane potential value and a second transmembrane potential value.
It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the invention, as claimed.
BRIEF DESCRIPTION OF THE DRAWINGS
The accompanying drawings, which are incorporated in and constitute a part of this disclosure, illustrate exemplary embodiments and, together with the description, serve to explain the disclosed principles:
FIG. 1 illustrates an exemplary block diagram of a system for determining myocardial ischemia severity based on hemodynamic parameters estimation, in accordance with some embodiments of the present disclosure.
FIG. 2 illustrates an example schematic diagram for determining severity of myocardial ischemia based on hemodynamic parameters estimation using the system of FIG.1, in accordance with some embodiments of the present disclosure.
FIG. 3 illustrates a flow diagram for determining myocardial ischemia severity based on hemodynamic parameters estimation using the system of FIG.1, in accordance with some embodiments of the present disclosure.
FIG. 4 illustrates schematic representation of a hemodynamic module for estimating hemodynamic parameters using the system of FIG.1, in accordance with some embodiments of the present disclosure.
FIG. 5 illustrates ventricular systole and diastole myocardial conditions of healthy conditions and ischemic conditions, in accordance with some embodiments of the present disclosure.
FIG. 6A illustrates simulated ECG signals showing myocardial ischemic severity, in accordance with some embodiments of the present disclosure.
FIG. 6B illustrates pressure volume loop showing left heart ventricle with myocardial ischemic severity in accordance with some embodiments of the present disclosure.
FIG. 6C illustrates simulated PPG signals showing myocardial ischemic severity in accordance with some embodiments of the present disclosure.
FIG. 7A illustrates simulated ECG signals for silent myocardial ischemia showing stressed and destressed condition in accordance with some embodiments of the present disclosure.
FIG. 7B illustrates pressure volume loop showing left heart ventricle for silent myocardial ischemia showing stressed and destressed condition in accordance with some embodiments of the present disclosure.
FIG. 7C illustrates simulated PPG signals for silent myocardial ischemia showing stressed and destressed condition in accordance with some embodiments of the present disclosure.
DETAILED DESCRIPTION OF EMBODIMENTS
Exemplary embodiments are described with reference to the accompanying drawings. In the figures, the left-most digit(s) of a reference number identifies the figure in which the reference number first appears. Wherever convenient, the same reference numbers are used throughout the drawings to refer to the same or like parts. While examples and features of disclosed principles are described herein, modifications, adaptations, and other implementations are possible without departing from the scope of the disclosed embodiments. It is intended that the following detailed description be considered as exemplary only, with the true scope being indicated by the following claims.
Embodiments herein provide a method and system for determining myocardial ischemia severity based on hemodynamic parameters estimation. The method disclosed, enables assessing progression of myocardial ischemic severity based on change occurred in cardiac ejection fraction. The present disclosure is a multi-model simulation of myocardial ischemia to assess disease progression with change in ischemic size and myocardial electrical propagation by observing the changes in hemodynamic parameters. The cardiac multi-model is coupling of a cardiac source model with a hemodynamic module to determine cardiac action transmembrane potential (TMP) of the heart surface model through contractility function. Further, the cardiac disease has a high variable manifestation due to difference in location and extent of damaged area, thus hampering the understanding of disease progression and stratification. Varying myocardial ischemia conditions are assessed based on the morphological changes occurred in a ventricular repolarization (ST) segment of the ECG template. Additionally, the present disclosure provides the assessment of disease progression based on various parameters such as ejection fraction, contractility, blood pressure and thereof for ischemic manifestation which leads to cardiac or heart failure. Three different conditions of myocardial ischemia have been simulated to determine disease progression, by way of experimental results and such results shall not be construed as limiting the scope of the present disclosure.
Referring now to the drawings, and more particularly to FIG. 1 through FIG. 7C, where similar reference characters denote corresponding features consistently throughout the figures, there are shown preferred embodiments and these embodiments are described in the context of the following exemplary system and/or method.
FIG. 1 illustrates an exemplary block diagram of a system for determining myocardial ischemia severity based on hemodynamic parameters estimation, in accordance with some embodiments of the present disclosure.
In an embodiment, the system 100 includes processor (s) 104, communication interface (s), alternatively referred as or input/output (I/O) interface(s) 106, and one or more data storage devices or memory 102 operatively coupled to the processor (s) 104. The system 100, with the processor(s) is configured to execute functions of one or more functional blocks of the system 100.
Referring to the components of the system 100, in an embodiment, the processor (s) 104 can be one or more hardware processors 104. In an embodiment, the one or more hardware processors 104 can be implemented as one or more microprocessors, microcomputers, microcontrollers, digital signal processors, central processing units, state machines, logic circuitries, and/or any devices that manipulate signals based on operational instructions. Among other capabilities, the processor(s) 104 is configured to fetch and execute computer-readable instructions stored in the memory. In an embodiment, the system 100 can be implemented in a variety of computing systems, such as laptop computers, notebooks, 10 hand-held devices, workstations, mainframe computers, servers, a network cloud, and the like.
The I/O interface(s) 106 can include a variety of software and hardware interfaces, for example, a web interface, a graphical user interface, and the like and can facilitate multiple communications within a wide variety of networks N/W and protocol types, including wired networks, for example, LAN, cable, etc., and wireless networks, such as WLAN, cellular, or satellite. In an embodiment, the I/O interface (s) 106 can include one or more ports for connecting a number of devices (nodes) of the system 100 to one another or to another server.
The memory 102 may include any computer-readable medium known in the art including, for example, volatile memory, such as static random access memory (SRAM) and dynamic random access memory (DRAM), and/or non-volatile memory, such as read only memory (ROM), erasable programmable ROM, flash memories, hard disks, optical disks, and magnetic tapes. The memory 102 comprises a plurality of modules 108 such as the cardiac source module 110 and the hemodynamic module 112 and so on, to implement the functions determine the myocardial ischemic severity using the system 100.
The modules 108 can be an Integrated Circuit (IC) (not shown), external to the memory 102, implemented using a Field-Programmable Gate Array (FPGA) or an Application-Specific Integrated Circuit (ASIC). The names (or expressions or terms) of the modules of functional block within the modules 108 referred herein, are used for explanation and are not construed to be limitation(s). The modules 108 includes the cardiac source module 110 for processing a plurality of Electrophysiology (EP) signals received from a heart surface model as an input, and the hemodynamic module 112 for estimating a plurality of hemodynamic parameters based on processing the plurality of Electrophysiology (EP) signals received from the cardiac source module 110. The cardiac source module 110 and the hemodynamic module 112 are coupled through a contractility function which in turn determines the compliance function of auricles and ventricles which brings pumping function of the heart source model.
FIG. 2 illustrates an example schematic diagram for determining severity of myocardial ischemia based on hemodynamic parameters estimation using the system of FIG. 1, in accordance with some embodiments of the present disclosure. FIG. 2 includes the cardiac source module 110 and the hemodynamic module 112. The cardiac source module 110 comprises a heart surface potential and a body surface potential. The heart surface potential uses myocyte model defining cardiac action potential or a mathematical equivalent approximating the cardiac transmembrane potential (TMP). The body surface potential is calculated by feeding the cardiac transmembrane potential (TMP) through a cardiac propagation model such as monodomain or bidomain equations and boundary conditions through proper torso coupling. These extensive field equations are solved using numerical techniques such as a Finite element method (FEM) for volume integration or a Boundary element method (BEM) for surface integration. Further, the body surface potential is generated for different myocardial ischemia episodes and a single lead ECG template derived to determine the myocardial ischemia progression based on changes in the single lead ECG template morphology, typically during a ventricular repolarization (ST) segment which characterizes ventricular depolarization (QRS) segment of the single lead ECG template.
In one embodiment, the hemodynamic module 112 estimates the output received from the cardiac source model 110 for determining the myocardial ischemic severity. The hemodynamic module 112 consists of a simulation model of patient’s heart or heart source model comprising four chambers with a systemic circulation, and a pulmonic circulation along with baroreflex auto regulation and the like. The heart chambers have been modeled as compliant vessels. Further, the pumping of the heart surface model is triggered through an autonomous contractility function derived from the cardiac source module 110. The simulated body surface potential (BSP) of the cardiac source module 110 drives the hemodynamic module 112, which modeled as four chambered heart with the pulmonic circulation and the systemic circulation. The integrated multi-model considers cellular to organ level manifestation of myocardial ischemia to simulate healthy heart dynamics and varying conditions of myocardial ischemia. The ground truth data of a healthy cardiac is generated based on all the varying conditions of ECG, blood pressure, left ventricle dynamics, ejection fraction and Photoplethysmogram (PPG) signal based on medical observations for close match. An example implementation of the system 100 for determining myocardial ischemic severity based on hemodynamic parameter estimation is described further with reference to FIG. 3.
FIG. 3 illustrates a flow diagram for determining myocardial ischemia severity based on hemodynamic parameters estimation using the system of FIG.1, in accordance with some embodiments of the present disclosure.
In an embodiment, the system 100 comprises one or more data storage devices or the memory 102 operatively coupled to the processor(s) 104 and is configured to store instructions for execution of steps of the method 300 by the processor(s) or one or more hardware processors 104. The steps of the method 300 of the present disclosure will now be explained with reference to the components or blocks of the system 100 as depicted in FIG. 1 and FIG. 2 and the steps of flow diagram as depicted in FIG. 3. Although process steps, method steps, techniques or the like may be described in a sequential order, such processes, methods and techniques may be configured to work in alternate orders. In other words, any sequence or order of steps that may be described does not necessarily indicate a requirement that the steps to be performed in that order. The steps of processes described herein may be performed in any order practical. Further, some steps may be performed simultaneously.
Referring now to the steps of the method 300, at step 302, the one or more hardware processors 104 receive a plurality of Electrophysiology (EP) signals from a heart surface model as an input. Each Electrophysiology (EP) signal from the plurality of Electrophysiology (EP) signals corresponds to cardiac action transmembrane potential (TMP) giving rise to cardiac contraction. The system 100 can be used, for example an anatomical model of patient’s heart referred as simulated heart surface model for determining the myocardial ischemic severity. The system 100 receives the plurality of Electrophysiology (EP) signals from a plurality of points of the heart surface model with its associated location information to create a diagnostic map of the heart surface model of the cardiac source module 110.
Referring now to the steps of the method 300, at step 304, the one or more hardware processors 104 generate, via the cardiac source module 110, a Forward Electrophysiology signal from the plurality of Electrophysiology (EP) signal. The plurality of Electrophysiology (EP) signals received from the heart surface model as an input to generate the Forward Electrophysiology signal, referring now to FIG.2. Electrocardiogram is based on a biophysical model that connects cardiac transmembrane potential (TMP) of representative myocytes on the heart surface model to electrocardiogram (ECG) signal on the surface of body. Geometrical parameters related to atria, ventricle and torso are reconstructed from magnetic resonance imaging.
Referring now to the steps of the method 300, at step 306, the one or more hardware processors 104 process the Forward Electrophysiology signal, to generate a single lead ECG template, wherein the single lead ECG template comprises at least one parameter comprising: (i) a auricular depolarization (PQ) segment, (ii) a ventricular depolarization (QRS) segment, (iii) a ventricular repolarization (ST) segment and combination thereof. Considering the above example, to generate the single lead ECG template, the cardiac source module 110 is expressed as equivalent double layer (EDL) of sources on the closed surface of the atrium and the ventricles. Referring now to FIG. 2, it is analogous to an equivalent source of the currents generated at the cell membrane during depolarization of the myocyte as referred earlier in the cardiac transmembrane potential (TMP). Here, the simulated patients heart surface is divided into a triangular mesh of 1500 elements or nodes, where each node poses an equivalent source which is proportional to the cardiac transmembrane potential (TMP) of the nearest myocyte. Further, time course of strength of the equivalent double layer (EDL) is an analytical function represented as sigmoid curve expressed as product of logistics function involving markers for the timing of the ventricular depolarization (QRS) segment and the ventricular repolarization (ST) segment for approximating the cardiac transmembrane potential (TMP). The source matrix (S) at node ‘n’ at time instant ‘t’ is as defined below in equation (1),
S (t;d,?)=D(t;d) R(t;?) -------------- equation (1)
where, ‘D’ is the depolarization phase and ‘R’ is the repolarization phase. The timing of local depolarization at node ‘n’ is denoted as ‘d’. The interval a= ?- d is taken as a measure of the local action potential duration. Such timing parameters and cardiac transmembrane potential (TMP) amplitudes can be varied to induce different conditions.
In one embodiment, based on the equivalent double layer (EDL), source model local strength at position ‘x’ on the surface of the myocardium can be mapped to potential generated at location on the body surface as described below in equation (2),
? (t,y)= ?¦?B (y,x) V_m (t,x) d_w (y,x)? ----------------- equation (2)
where, B(y,x) is the transfer function expressing the volume conductor model, considering geometry and conductivity in the chest cavity,
V_m, is the local transmembrane potential (TMP) at heart surface model,
d_w (y,x), is the solid angle subtended at y by the surface element dS(x) of the myocardinal node S_v. The volume conductor model as expressed above in equation 2, cannot be solved analytically due to complex assymetrical shape of individual compartments using the specialized Boundary element method (BEM). Further, potential at discretized body surface model consisting of ‘l’ lead position can be described as shown below in equation (3),
?(t,l)= ?_n¦?B(l,n)S (t;d,?)? ------------- equation (3)
where, ‘B’ is a transfer matrix, incorporating the solid angles subtended by source elements as viewed from the nodes of the triangulate surface. The elements of the transfer matrix ‘B’ expresses the source strengths of all ‘n’ (n=1500) nodes on the heart surface potentials at ‘l’ (l=256) lead positions on the torso surface. Further, the resulting matrix ‘?’ generates the standard 12 lead ECG template. The generated single lead ECG template serves as the driving signal to the hemodynamic module 112 as described in the next step of the present disclosure.
Referring now to the steps of the method 300, at step 308, the one or more hardware processors 104 estimate, via the hemodynamic module 112, a plurality of hemodynamic parameters based on the single lead ECG template, wherein the plurality of hemodynamic parameters comprises a left heart atrium compliance function C_la (t) and a left heart ventricle compliance function C_lv (t). Referring now to FIG. 4, the generated single lead ECG signal served as the driving signal to the hemodynamic module 112 for estimating the left heart atrium compliance function C_la (t) and the left heart ventricle compliance function C_lv (t). The hemodynamic module 112 consists of simulated heart surface model which includes four chambers with the systemic circulation and the pulmonic circulation along the baroflex auto regulation and the like. The vasculature of major vessels is modeled as combination of resistive and capacitive tube. Further, all the major heart valves have been modeled to work in synchronized manner corresponding to auricular depolarization and ventricular repolarization of the heart chambers, thereby bringing the pulsatile effect with pressure gradient generation and volumetric change in the blood flow. The coupling of cardiac source module 110 and the hemodynamic module 112 enables to determine the compliance of the atrium and the ventricles for the pumping action of the heart surface model. Further, the driving signal lead ECG template received from the cardiac source module 110 is decomposed into its characteristic constituents such as the auricular depolarization (PQ) segment, the ventricular depolarization (QRS) segment and the ventricular repolarization (ST) segment. Changes encoded to modulate compliance function and timing information to control synchronized operation of the four heart chambers.
In one embodiment, the left heart atrium compliance function C_la (t) is computed based on atleast one of (i) a minimum value of the left heart atrium, (ii) a maximum value of the left heart atrium, (iii) a left heart atrium activation function, and (iv) a time delay in firing between the left heart atrium and the left heart ventricle as described below in equation (4),
C_la (t)= C_(min,la)+0.5 (C_(max,la)- C_(max,la) ) A_la (t-D) --------------- equation (4)
where, C_(min,la) is the minimum compliance function of the left heart atrium, C_(max,la) is the maximum compliance function of the left heart atrium, D is the time delay in firing between the left heart atrium and the left heart ventricle, and A_la is the left heart atrium activation function. Further, the left heart atrium activation function is computed based on the left heart atrium activation time analogous to the auricular depolarization (PQ) segment and the time duration of the cardiac cycle as described below in equation (5),
A_la= {¦(0 0=t=T_a@1-cos?(2p (t -T_a)/(T-T_a )) ? T?_a=t
Documents
Orders
Section
Controller
Decision Date
Application Documents
#
Name
Date
1
202021036165-IntimationOfGrant17-12-2024.pdf
2024-12-17
1
202021036165-STATEMENT OF UNDERTAKING (FORM 3) [21-08-2020(online)].pdf
2020-08-21
1
202021036165-Written submissions and relevant documents [02-07-2024(online)].pdf
2024-07-02
2
202021036165-FORM-26 [24-06-2024(online)]-1.pdf
2024-06-24
2
202021036165-PatentCertificate17-12-2024.pdf
2024-12-17
2
202021036165-REQUEST FOR EXAMINATION (FORM-18) [21-08-2020(online)].pdf
2020-08-21
3
202021036165-FORM 18 [21-08-2020(online)].pdf
2020-08-21
3
202021036165-FORM-26 [24-06-2024(online)].pdf
2024-06-24
3
202021036165-Written submissions and relevant documents [02-07-2024(online)].pdf
2024-07-02
4
202021036165-FORM-26 [24-06-2024(online)]-1.pdf
2024-06-24
4
202021036165-FORM 1 [21-08-2020(online)].pdf
2020-08-21
4
202021036165-Correspondence to notify the Controller [21-06-2024(online)].pdf