Biological information processing device, operation method of biological information processing device, and control program for biological information processing device

Abstract

To execute monitoring of myocardial ischemia from ventricular pacing or an electrocardiogram waveform of a left leg block.SOLUTION: A biological information processing device 100 includes a determination unit 120, an ST measuring unit 130, and an analysis unit 140. The determination unit 120 determines that an electrocardiogram waveform of a subject is an electrocardiogram waveform corresponding to at least one of ventricular pacing pulsation and left leg block pulsation from the electrocardiogram waveform of the subject. The ST measuring unit 130 executes ST measurement by applying an evaluation criterion of myocardial ischemia to the determined electrocardiogram waveform. The analysis unit 140 analyzes a result of the ST measurement, and outputs the analysis result and information on the myocardial ischemia audibly or visually.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] The present invention relates to a bioinformation processing device and a bioinformation processing method capable of monitoring myocardial ischemia from an electrocardiogram waveform of ventricular pacing or left bundle branch block. Operation of the device The present invention relates to a method and a control program for a biological information processing device. [Background technology]

[0002] To monitor myocardial ischemia such as myocardial infarction and angina pectoris, the deviation (ST value) of the ST segment (the portion between the S wave and the T wave) of the electrocardiogram waveform from the baseline is measured. Generally, the ST value is used as an indicator of the presence or absence of myocardial ischemia in an electrocardiogram waveform obtained when the ventricles contract via a normal conduction system. If the ST segment of the electrocardiogram waveform rises or falls from the baseline, myocardial ischemia is suggested (see Patent Document 1).

[0003] However, in the case of ventricular pacing or left bundle branch block, the shape of the electrocardiogram waveform changes significantly compared to the electrocardiogram waveform during general myocardial ischemia. If the shape of the electrocardiogram waveform changes significantly, the ST value obtained from that electrocardiogram waveform will differ significantly from the ST value obtained from the electrocardiogram waveform during general myocardial ischemia. For this reason, in the case of ventricular pacing or left bundle branch block, it is difficult to monitor myocardial ischemia using only the ST value, as in the past.

[0004] For these reasons, myocardial ischemia is no longer monitored using ST values ​​during ventricular pacing or in patients with left bundle branch block. [Prior art documents] [Patent documents]

[0005] [Patent Document 1] Patent No. 6595582 specification Summary of the Invention [Problem to be solved by the invention]

[0006] Recently, the Sgarbossa and Smith criteria have become known as criteria for assessing ischemia in cases of ventricular pacing or left bundle branch block.

[0007] Myocardial ischemia can occur in patients undergoing ventricular pacing or patients with left bundle branch block, so there is a demand for the ability to monitor myocardial ischemia.

[0008] However, because the ST values ​​of ventricular-paced beats are affected by the pacing pulses output from the pacemaker, simply including the ST values ​​in the monitoring range could lead to confusion in the displayed ST values. For this reason, it is preferable to treat the ST values ​​of ventricular-paced beats separately from general ST values. Similarly, it is preferable to treat the ST values ​​of left bundle branch block beats separately from general ST values, just like the ST values ​​of ventricular-paced beats. It is known that the electrocardiogram waveform of ventricular-paced beats with a lead placed in the right ventricle is similar to that of left bundle branch block beats.

[0009] The inventors thought that by applying the Sgarbossa and Smith criteria in addition to conventional measurements such as the ST value of an electrocardiogram waveform, it might be possible to monitor myocardial ischemia with some ingenuity, even in cases of ventricular pacing or left bundle branch block.

[0010] The present invention has been made to meet such demands, and aims to provide a bioinformation processing device, a bioinformation processing method, and a control program for the bioinformation processing device that can monitor myocardial ischemia from electrocardiogram waveforms, even if the electrocardiogram waveforms are those of ventricular pacing or left bundle branch block. [Means for solving the problem]

[0011] To achieve the above object, the biological information processing device of the present invention includes a determination unit, an ST measurement unit, and an analysis unit. The determination unit determines from a subject's electrocardiogram waveform that an electrocardiogram waveform corresponds to at least one of ventricular pacing beats and left bundle branch block beats. The ST measurement unit performs ST measurement by applying evaluation criteria for myocardial ischemia to the determined electrocardiogram waveform. The analysis unit analyzes the results of the ST measurement and outputs the analysis results and information related to myocardial ischemia audibly or visually.

[0012] To achieve the above-mentioned object, the bioinformation processing method of the present invention includes a step of determining from a subject's electrocardiogram waveform that the electrocardiogram waveform corresponds to at least one of a ventricular pacing beat and a left bundle branch block beat, a step of performing ST measurement by applying evaluation criteria for myocardial ischemia to the determined electrocardiogram waveform, and a step of analyzing the results of the ST measurement and outputting the analysis results and information related to myocardial ischemia audibly or visually.

[0013] In order to achieve the above-mentioned object, the control program of the bioinformation processing device of the present invention causes a computer that functions as a bioinformation processing device to function as a determination unit that determines from the electrocardiogram waveform of a subject that an electrocardiogram waveform corresponds to at least one of a ventricular pacing beat and a left bundle branch block beat, an ST measurement unit that performs ST measurement by applying evaluation criteria for myocardial ischemia to the determined electrocardiogram waveform, and an analysis unit that analyzes the results of the ST measurement and outputs the analysis results and information related to myocardial ischemia audibly or visually. [Effects of the Invention]

[0014] The biological information processing device, biological information processing method, and control program for the biological information processing device of the present invention enable monitoring of myocardial ischemia based on electrocardiogram waveforms of ventricular pacing or left bundle branch block, which has been difficult to monitor in the past. [Brief explanation of the drawings]

[0015] [Figure 1] FIG. 1 is a block diagram of a biometric information processing apparatus according to an embodiment of the present invention. [Figure 2]This is the main flowchart of the biological information processing device according to this embodiment. [Figure 3] This is the subroutine flowchart of the <Create representative waveform> step in the flowchart of FIG. 2. [Figure 4] This is the subroutine flowchart of the <ST measurement> step in the flowchart of FIG. 2. [Figure 5] This is the subroutine flowchart of the <Determination based on Sgarbossa's criterion> step in the flowchart of FIG. 4. [Figure 6] This is the subroutine flowchart of the <Determination based on Smith's criterion> step in the flowchart of FIG. 4. [Figure 7] This is the subroutine flowchart of the <Determine whether notification conditions are met> step in the flowchart of FIG. 2. [Figure 8] This is the subroutine flowchart of the <ST measurement> step in the flowchart of FIG. 2 in Embodiment 2. [Figure 9] This is the subroutine flowchart of the <Determination based on Sgarbossa's criterion> step in the flowcharts (FIG. 8, FIG. 12) in Embodiments 2 and 3. [Figure 10] This is the subroutine flowchart of the <Determination based on Smith's criterion> step in the flowcharts (FIG. 8, FIG. 12) in Embodiments 2 and 3. [Figure 11] This is the subroutine flowchart of the <Determine whether notification conditions are met> step in the flowchart of FIG. 2 in Embodiment 2. [Figure 12] This is the subroutine flowchart of the <ST measurement> step in the flowchart of FIG. 2 in Embodiment 3. [Figure 13] This is the subroutine flowchart of the <Determination of left bundle branch block> in the <Is the representative waveform ventricular pacing or left bundle branch block?> step in the flowchart of FIG. 12. [Figure 14]11 is a subroutine flowchart of the step <Determine whether notification conditions are met> in the flowchart of FIG. 2 in the third embodiment. [Figure 15] FIG. 1 is a diagram showing a normal electrocardiogram waveform. [Figure 16] FIG. 1 is a diagram showing an electrocardiogram waveform suggesting myocardial ischemia. [Figure 17] FIG. 14 is a diagram showing the waveform of rS or QS type in lead V1 used to determine left bundle branch block in the flowchart of FIG. [Figure 18] FIG. 14 is a diagram showing an R-shaped waveform in lead V6 used to determine left bundle branch block in the flowchart of FIG. [Figure 19] FIG. 10 is a diagram showing the setting range of the ST alarm. [Figure 20] FIG. 10 is a diagram showing the setting range of the STJ alarm. [Figure 21] FIG. 10 is a diagram showing the setting range of the STJ / QRS alarm. [Figure 22] FIG. 10 is a diagram showing the setting range of the Sgarbossa / Smith determination threshold. [Figure 23] FIG. 10 is a diagram showing specific examples of ST values ​​and ST recall waveforms. [Figure 24] FIG. 10 is a diagram illustrating the display form of ST recall. DETAILED DESCRIPTION OF THE INVENTION

[0016] Hereinafter, embodiments of the biometric information processing device of the present invention will be described in the following, divided into [Embodiment 1] to [Embodiment 3].

[0017] [Embodiment 1] (Configuration of Biometric Information Processing Device) Fig. 1 is a block diagram of a biological information processing device of this embodiment. The configuration of the biological information processing device in Fig. 1 is common to all of Embodiments 1 to 3. The biological information processing device 100 has a determination unit 120, an ST measurement unit 130, and an analysis unit 140.

[0018] The determination unit 120 inputs an electrocardiogram waveform from the electrodes 110 attached to the subject's body, and determines from the electrocardiogram waveform of the subject that the electrocardiogram waveform corresponds to at least one of a ventricular pacing beat and a left bundle branch block beat.

[0019] The ST measuring unit 130 performs ST measurement by applying the evaluation criteria for myocardial ischemia to the electrocardiogram waveform determined by the determining unit 120. Specifically, the ST measuring unit 130 performs ST measurement by applying, to the electrocardiogram waveform determined by the determining unit 120, a determination based on the Sgarbossa criteria and the Smith criteria, and a measurement value related to the shape of the electrocardiogram waveform determined as a ventricular pacing beat or a measurement value related to the shape of the electrocardiogram waveform determined as a left bundle branch block beat, as its own evaluation criteria for myocardial ischemia.

[0020] The analysis unit 140 analyzes the results of the ST measurement performed by the ST measurement unit 130 and outputs the analysis results and information related to myocardial ischemia audibly or visually. An example of the audible output is sounding an alarm, and an example of the visual output is displaying a message. Specifically, the analysis unit 140 outputs an alarm when the STJ value exceeds a set alarm threshold, and outputs a message when the STJ value meets the Sgarbossa criteria and the Smith criteria even if it does not exceed the set alarm threshold.

[0021] The determination unit 120 has a heartbeat detection unit 122, a pulse detection unit 124, and a heartbeat determination unit 126. The heartbeat detection unit 122 receives an electrocardiogram waveform from the electrodes 110 and detects the heartbeat of the subject. The pulse detection unit 124 detects the presence or absence of a pacing pulse from a pacemaker attached to the subject.

[0022] The heartbeat determination unit 126 classifies the subject's electrocardiogram waveform into electrocardiogram waveforms corresponding to at least one of ventricular pacing beats and left bundle branch block beats based on the subject's heartbeat detected by the heartbeat detection unit 122 and the presence or absence of a pacing pulse detected by the pulse detection unit 124, creates a group of ventricular pacing beats or a group of left bundle branch block beats, and determines that the electrocardiogram waveform corresponds to at least one of ventricular pacing beats and left bundle branch block beats using a representative waveform created from the group of ventricular pacing beats or the group of left bundle branch block beats.

[0023] The biological information processing device 100 further includes a notification unit 150. The notification unit 150 notifies the user of the analysis results output by the analysis unit 140, and alarms or messages related to myocardial ischemia. The notification unit 150 displays on the screen the representative waveform created by the determination unit 120 and measurement values ​​related to the shape of the electrocardiogram waveform as the analysis results of the ST measurement by the ST measurement unit 130. The notification unit 150 also has a function of selectively switching the electrocardiogram waveform displayed on the screen between normal beats, ventricular-paced beats, and left bundle branch block beats. The notification unit 150 also has a function of registering the electrocardiogram waveforms of normal beats, ventricular-paced beats, and left bundle branch block beats. The notification unit 150 also displays the border of the electrocardiogram waveform to be displayed darker as the ST value of the electrocardiogram waveform increases.

[0024] The biological information processing device 100 further includes an analysis control unit 160, an operation unit 170, and a storage unit 180. The analysis control unit 160 comprehensively controls the operations of the pulse detection unit 124, the heartbeat determination unit 126, and the analysis unit 140. The operation unit 170 instructs the analysis control unit 160 to perform various settings. The storage unit 180 stores control programs for the determination unit 120, the ST measurement unit 130, and the analysis unit 140. The storage unit 180 also stores information related to electrocardiogram waveforms that are input or analyzed during processing by the determination unit 120, the ST measurement unit 130, and the analysis unit 140, and stores information to be displayed on the notification unit 150.

[0025] (Operation of biometric information processing device) The above is a general configuration of the biometric information processing device 100 of this embodiment. Next, the operation of the biometric information processing device of this embodiment will be described.

[0026] The operation of the biological information processing device 100 of this embodiment also implements a biological information processing method of the biological information processing device 100. The biological information processing method is a biological information processing method that enables monitoring of myocardial ischemia from an electrocardiogram waveform, even if the electrocardiogram waveform is ventricular pacing or left bundle branch block, and includes a step of determining from the electrocardiogram waveform of a subject that the electrocardiogram waveform corresponds to at least one of a ventricular pacing beat and a left bundle branch block beat, a step of performing ST measurement by applying evaluation criteria for myocardial ischemia to the determined electrocardiogram waveform, and a step of analyzing the result of the ST measurement and outputting the analysis result and an alarm or message related to myocardial ischemia.

[0027] The operation of the biological information processing device 100 of this embodiment is controlled by a computer constituting the biological information processing device 100. A control program for controlling the operation of the biological information processing device 100 of this embodiment is stored in the storage unit 180 of FIG. 1. The control program of the biological information processing device 100 is a control program for the biological information processing device 100 that enables monitoring of myocardial ischemia from electrocardiogram waveforms, even if the electrocardiogram waveform is ventricular pacing or left bundle branch block. The control program causes the computer functioning as the biological information processing device 100 to function as a determination unit 120 that determines, from the electrocardiogram waveform of a subject, that an electrocardiogram waveform corresponds to at least one of a ventricular pacing beat and a left bundle branch block beat, an ST measurement unit 130 that performs ST measurement by applying evaluation criteria for myocardial ischemia to the determined electrocardiogram waveform, and an analysis unit 140 that analyzes the results of the ST measurement and outputs the analysis result and an alarm or message related to myocardial ischemia.

[0028] (Main flowchart) Fig. 2 is a main flowchart of the biometric information processing device of this embodiment. The main flowchart of Fig. 2 is executed by a computer constituting the biometric information processing device 100. The main flowchart of Fig. 2 is common to the first to third embodiments.

[0029] First, the determination unit 120 receives an electrocardiogram waveform from the electrodes 110 and measures the electrocardiogram waveform of the subject. There are three-electrode, six-electrode, and ten-electrode methods for monitoring the electrocardiogram waveform. The determination unit 120 measures a one-lead electrocardiogram waveform in the case of three electrodes, an eight-lead electrocardiogram waveform in the case of six electrodes, and a 12-lead electrocardiogram waveform in the case of ten electrodes (S100). Note that in the first embodiment, three electrodes are assumed, and therefore a one-lead electrocardiogram waveform is measured.

[0030] Next, the storage unit 180 stores the electrocardiogram waveform measured by the determination unit 120. The storage unit 180 stores one electrocardiogram waveform of one lead in the case of three electrodes, eight electrocardiogram waveforms of eight leads in the case of six electrodes, and twelve electrocardiogram waveforms of 12 leads in the case of ten electrodes (S200). Note that in the first embodiment, three electrodes are assumed, so one electrocardiogram waveform is stored.

[0031] Next, the determination unit 120 determines whether a certain time has elapsed since the previous ST measurement performed by the ST measurement unit 130 (S300). Specifically, the ST measurement unit 130 performs ST measurement by applying, to the electrocardiogram waveform, a determination based on the Sgarbossa criteria and the Smith criteria, and a measurement value related to the shape of the electrocardiogram waveform determined to be a ventricular-paced beat or a measurement value related to the shape of the electrocardiogram waveform determined to be a left bundle branch block beat, as evaluation criteria for myocardial ischemia. Therefore, the determination unit 120 determines whether a certain time has elapsed since such ST measurement was performed. The details of the ST measurement will be described later.

[0032] If a certain time has not elapsed since the previous ST measurement (S300: NO), the determination unit 120 performs the process of step S100. On the other hand, if a certain time has elapsed since the previous ST measurement (S300: YES), the determination unit 120 creates a representative waveform from the electrocardiogram waveforms stored in the storage unit 180 (S400). Specifically, the determination unit 120 classifies the electrocardiogram waveforms of the subject stored in the storage unit 180 into electrocardiogram waveforms corresponding to at least one of ventricular pacing beats and left bundle branch block beats, creates a group of ventricular pacing beats or a group of left bundle branch block beats, and creates a representative waveform from the group of ventricular pacing beats or the group of left bundle branch block beats. Note that if the electrocardiogram waveforms stored in the storage unit 180 contain a lot of noise or if the electrocardiogram waveforms are not properly grouped, it may not be possible to create a representative waveform. Details of creating a representative waveform will be described later.

[0033] The determination unit 120 determines whether or not a representative waveform has been created (S500). If a representative waveform has not been created (S500: NO), the determination unit 120 performs the process of step S100. On the other hand, if a representative waveform has been created (S500: YES), the ST measurement unit 130 performs ST measurement (S600). Specifically, when the number of electrodes attached to the subject is three, i.e., in the case of three electrodes, the ST measurement unit 130 performs determination based on the Sgarbossa criteria and the Smith criteria by determining whether or not the electrocardiogram waveform determined to be a ventricular pacing beat conforms to the Sgarbossa criteria and the Smith criteria.

[0034] When the number of electrodes attached to the subject is 6 or 10, i.e., when there are 6 or 10 electrodes, the determination is made based on the Sgarbossa criteria and Smith criteria depending on the score obtained when the electrocardiogram waveform determined to be a ventricular pacing beat is compared to the case of 3 electrodes, and when there are 10 electrodes, the determination is made based on the Sgarbossa criteria and Smith criteria depending on the score obtained when the electrocardiogram waveform determined to be a left bundle branch block beat is compared to the Sgarbossa criteria and Smith criteria depending on the score obtained when the electrocardiogram waveform is compared to the electrocardiogram waveform determined to be a ventricular pacing beat in the case of 6 electrodes.

[0035] Furthermore, when the number of electrodes attached to the subject is 6 or 10, i.e., when there are 6 or 10 electrodes, the ST measurement unit 130 determines the scores of the Sgarbossa criteria and the Smith criteria for the electrocardiogram waveform of the ventricular pacing beat or left bundle branch block beat for each lead, and calculates the total score for all leads, thereby making a judgment based on the Sgarbossa criteria and the Smith criteria.

[0036] The analysis unit 140 registers an ST recall in response to the determination result of the ST measurement unit 130 (S700). Specifically, it registers an ST value and a recalled ST waveform as shown in FIG. 23. The analysis unit 140 determines whether the registered ST recall satisfies the notification condition (S800). If the registered ST recall does not satisfy the notification condition (S800: NO), the determination unit 120 performs the process of step S100. On the other hand, if the registered ST recall satisfies the notification condition (S800: YES), the analysis unit 140 outputs a notification (alarm / message) to the notification unit 150 (S900). Upon receiving this notification, the notification unit 150 audibly or visually notifies the analysis result and information related to myocardial ischemia output by the analysis unit 140. The process of determining whether the notification condition is satisfied will be described in detail later.

[0037] The analysis control unit 160 determines whether the measurement has ended (S1000). If the measurement has not ended (S1000: NO), the determination unit 120 performs the processing of step S100. On the other hand, if the measurement has ended (S1000: YES), the measurement process ends.

[0038] The above is the schematic processing content of the main flowchart of the biological information processing apparatus according to Embodiment 1. Next, the subroutine flowcharts of <Create representative wave> in step S400, <ST measurement> in step S600, and <Meet notification conditions?> in step S800 in the main flowchart of FIG. 2 will be described.

[0039] (Subroutine flowchart) <Create representative wave> FIG. 3 is a subroutine flowchart of the <Create representative waveform> step in the flowchart of FIG. 2. Note that the subroutine flowchart of FIG. 3 is common to Embodiments 1 to 3.

[0040] The heartbeat determination unit 126 monitors the electrocardiogram waveform input from the heartbeat detection unit 122 and excludes the electrocardiogram waveform with noise (S410). The determination as to whether the electrocardiogram waveform has noise is made by monitoring whether the shape and characteristic values of each part of the input electrocardiogram waveform and the standard electrocardiogram waveform as shown in FIG. 15 are within the allowable range. For example, if each point such as the ISO point, J point, and ST point of the input electrocardiogram waveform (see FIG. 16) deviates greatly from the allowable range, it is determined that the electrocardiogram waveform has noise, and the electrocardiogram waveform is excluded. The determination as to whether there is noise can be made by applying a general method that has been conventionally used. In addition, each point such as the ISO point, J point, and ST point can be arbitrarily set by the operation unit 170.

[0041] Next, the heartbeat determination unit 126 groups the input electrocardiogram waveforms according to the presence or absence of a pacing pulse and the shape of the electrocardiogram waveform (S420). The presence or absence of a pacing pulse can be recognized from the output from the pulse detection unit 124. If the subject is fitted with a pacemaker, the electrocardiogram waveform may contain a pacing pulse. When the pulse detection unit 124 detects a pacing pulse, a signal to that effect is output to the heartbeat determination unit 126, which then determines whether the electrocardiogram waveform detected by the heartbeat detection unit 122 contains a pacing pulse or not. Therefore, the heartbeat determination unit 126 can group the input electrocardiogram waveforms according to the presence or absence of a pacing pulse and their shape. Grouping by shape may be performed based on the similarity of the shape of the electrocardiogram waveform itself, as shown in FIGS. 15 and 16, or by measuring the feature values ​​of each part of the electrocardiogram waveform. An example of grouping performed in the processing of this step is grouping into normal beats, atrial-paced beats, and ventricular-paced beats. Furthermore, even within the groups classified into normal beats, atrial-paced beats, and ventricular-paced beats, the beats are further grouped based on the similarity of the shape of the electrocardiogram waveform itself or the feature values ​​of each part of the electrocardiogram waveform. For example, normal beats are grouped based on the similarity of the shape of the electrocardiogram waveform itself or the feature values ​​of each part of the electrocardiogram waveform. The same applies to atrial-paced beats and ventricular-paced beats.

[0042] Next, the heartbeat determination unit 126 determines whether there is a group of normal beats or atrial pacing beats in the electrocardiogram waveform grouped in step S420 (S430). If there is a group of normal beats or atrial pacing beats (S430: YES), a representative waveform is created from the average waveform of the group in which the most beats are classified among the group of normal beats or atrial pacing beats (S440). For example, in each of normal beats, atrial pacing beats, and ventricular pacing beats, since they are grouped by the similarity of the shape of the electrocardiogram waveform itself or the characteristic values of each part of the electrocardiogram waveform, if it is a normal beat, the average waveform (the waveform averaged in the group) of the group in which the most beats are classified among the grouped normal beat groups is created, and this average waveform is used as the representative waveform of the normal waveform. The same applies to atrial pacing beats and ventricular pacing beats.

[0043] On the other hand, if there is no group of normal beats or atrial pacing beats (S430: NO), it is determined whether there is a group of ventricular pacing beats (S450). If there is a group of ventricular pacing beats (S450: YES), a representative waveform is created from the average waveform of the group in which the most beats are classified among the group of ventricular pacing beats (S460). If there is no group of ventricular pacing beats (S450: NO), the process of "creating a representative waveform" is terminated.

[0044] <ST measurement> FIG. 4 is a subroutine flowchart of the <ST measurement> step of the flowchart of FIG. 2. Note that the subroutine flowchart of FIG. 4 is applicable only to Embodiment 1 assuming three electrodes.

[0045] The ST measurement unit 130 determines the measurement reference point of the representative waveform created in the subroutine flowchart of <creating a representative waveform> (see FIG. 3) (S610). The measurement reference point of the representative waveform is the ISO point or the J point shown in the electrocardiogram waveform of FIG. 16. Note that the ISO point is the potential of the flat point at the start of the QRS complex (the starting point of the Q wave), and the J point is the potential of the inflection point of the curve from the S wave to the T wave.

[0046] Next, the ST measuring unit 130 measures the shape of the representative waveform (S620). The shape of the representative waveform is not determined qualitatively, but is a quantitatively determined characteristic value of each part of the representative waveform, such as the STJ value, ST60 value, and QRS main peak amplitude, shown in the electrocardiogram waveforms of Figures 15 and 16. The STJ value is the potential at the J point, the ST60 value is the potential 60 msec behind the J point, and the QRS main peak amplitude is the potential relative to the baseline of the highest point among the Q wave, R wave, and S wave.

[0047] Next, the ST measurement unit 130 determines whether the representative waveform is ventricular pacing (S630). If the representative waveform is ventricular pacing (S630: YES), it performs a determination based on the Sgarbossa criteria (S640) and a determination based on the Smith criteria (S650), and outputs the representative waveform, measurement reference point, STJ value, STJ / QRS main peak amplitude, whether the Sgarbossa criteria are met, and whether the Smith criteria are met to the analysis unit 140 (S660). The determination based on the Sgarbossa criteria and the determination based on the Smith criteria will be described later.

[0048] On the other hand, if the representative waveform is not ventricular pacing (S630: NO), the representative waveform, measurement reference point, STJ value, and ST60 value are output to the analysis unit 140 (S670).

[0049] <Judgment based on Sgarbossa's criteria> Fig. 5 is a subroutine flowchart of the step <Determination based on Sgarbossa's criterion> in the flowchart of Fig. 4. Note that the subroutine flowchart of Fig. 5 is applied only to the first embodiment which assumes three electrodes.

[0050] The analysis unit 140 determines whether the main QRS peak and the STJ change of the representative waveform are in the same direction (S641), as shown in Figures 15 and 16. The main QRS peak is the highest point among the Q wave, R wave, and S wave, and the STJ change is the change in the STJ value (potential at the J point) based on the ISO point. Therefore, if the representative waveform is an electrocardiogram waveform as shown in Figures 15 and 16, the main QRS peak and the STJ change of the representative waveform are both in the positive direction, and are therefore determined to be in the same direction. Note that the setting range of the STJ change in the same direction as the QRS can be set within a certain range using the operation unit 170 (see Figure 1), like the Sgarbossa / Smith determination threshold shown in Figure 22. The setting range is in 0.01 mV increments, with the initial value being 0.1, from 0.10 mV to 1.00 mV. The setting range can also be set as a distance (mm) on the electrocardiogram waveform graph instead of voltage. In this case, the setting range is 1.0 mm to 10.0 mm in increments of 0.1 mm, with an initial value of 1.0. The setting range for STJ changes in the direction opposite to the QRS can be set within a certain range using the operation unit 170 (see FIG. 1), similar to the Sgarbossa / Smith threshold value shown in FIG. 22. The setting range is 0.1 mV to 1.0 mV in increments of 0.01 mV, with an initial value of 0.5. The setting range can also be set as a distance (mm) on the electrocardiogram waveform graph instead of voltage. In this case, the setting range is 1.0 mm to 10.0 mm in increments of 0.1 mm, with an initial value of 5.0.

[0051] If the QRS main peak of the representative waveform and the STJ change are in the same direction (S641: YES), it is then determined whether the STJ change is 0.1 mV or more (S642).If the STJ change is 0.1 mV or more (S642: YES), it is determined that the representative waveform meets the Sgarbossa criterion (S643).

[0052] If the QRS main peak of the representative waveform and the STJ change are not in the same direction (S641: NO), then it is determined whether the STJ change is 0.5 mV or more (S644). If the STJ change is 0.5 mV or more, it is determined that the representative waveform meets the Sgarbossa criterion (S643).

[0053] If it is determined in step S642 that the STJ change amount is not 0.1 mV or more (S642: NO), or if it is determined in step S644 that the STJ change amount is not 0.5 mV or more (S644: NO), it is determined that the representative waveform does not meet the Sgarbossa criterion (S645).

[0054] <Judgment based on Smith's criteria> Fig. 6 is a subroutine flowchart of the step <Determination based on Smith's criteria> in the flowchart of Fig. 4. Note that the subroutine flowchart of Fig. 6 is applied only to the first embodiment which assumes three electrodes.

[0055] The analysis unit 140 determines whether the main QRS peak and the STJ change of the representative waveform are in the same direction (S651), as shown in Figures 15 and 16. The main QRS peak is the highest point among the Q wave, R wave, and S wave, and the STJ change is a change in the STJ value (potential at the J point) based on the ISO point. Therefore, if the representative waveform is an electrocardiogram waveform as shown in Figures 15 and 16, the main QRS peak and the STJ change of the representative waveform are both in the positive direction, and are therefore determined to be in the same direction. Note that, as with the above, the setting range of the STJ change in the same direction as the QRS can be set within a certain range by the operation unit 170 (see Figure 1), like the Sgarbossa / Smith determination threshold in Figure 22.

[0056] If the QRS main peak of the representative waveform and the STJ change are in the same direction (S651: YES), it is then determined whether the STJ change is 0.1 mV or more (S652).If the STJ change is 0.1 mV or more (S652: YES), it is determined that the representative waveform meets the Smith criteria (S653).

[0057] If the QRS main peak and STJ change of the representative waveform are not in the same direction (S651: NO), then it is determined whether the STJ change amount / QRS main peak amplitude is greater than 0.25 (S654).If the STJ change amount / QRS main peak amplitude is greater than 0.25, it is determined that the representative waveform meets the Smith criteria (S653).

[0058] If it is determined in step S652 that the STJ change is not 0.1 mV or more (S652: NO), or if it is determined in step S654 that the STJ change / QRS main peak amplitude is 0.25 or less (S654: NO), it is determined that the representative waveform does not meet the Smith criteria (S655).

[0059] <Determine whether notification conditions are met> Fig. 7 is a subroutine flowchart of the step <Determine whether notification conditions are met> in the flowchart of Fig. 2. Note that the subroutine flowchart of Fig. 7 is applied only to the first embodiment which assumes three electrodes.

[0060] The ST measurement unit 130 determines whether the representative waveform created in the subroutine flowchart of "Create Representative Waveform" (see FIG. 3) is ventricular pacing (S810). If the representative waveform is ventricular pacing (S810: YES), the analysis unit 140 then determines whether the STJ value exceeds the alarm threshold (S820). Note that the upper and lower limits of the STJ value alarm can be set within a certain range using the operation unit 170 (see FIG. 1), as shown in FIG. 20. The setting range is in 0.01 mV increments, with the upper limit from -1.99 mV to +2.00 mV and the lower limit from -2.00 mV to +1.99 mV. The upper and lower limit settings can also be turned off. The setting range can also be set as a distance in mm on the electrocardiogram waveform graph instead of voltage, in which case the setting range is in 0.1 mm increments, with the upper limit from -19.99 mm to +20.0 mm and the lower limit from -20.0 mm to +19.99 mm. The upper and lower limit settings can also be turned off.

[0061] If the STJ value exceeds the alarm threshold (S820: YES), the notification unit 150 outputs an alarm (S830). On the other hand, if the representative waveform is not ventricular pacing (S810: NO), the analysis unit 140 then determines whether the ST60 value exceeds the alarm threshold (S860). Note that, as shown in FIG. 19, the upper and lower limits of the ST60 alarm can be set within a certain range using the operation unit 170 (see FIG. 1). The setting range is in 0.01 mV increments, with the upper limit from -1.99 mV to +2.00 mV and the lower limit from -2.00 mV to +1.99 mV. The upper and lower limit settings can also be turned off. The setting range can also be set as a distance in mm on the electrocardiogram waveform graph instead of voltage, in which case the setting range is in 0.1 mm increments, with the upper limit from -19.9 mm to +20.0 mm and the lower limit from -20.0 mm to +19.9 mm. The upper and lower limit settings can also be turned off.

[0062] If the ST60 value exceeds the alarm threshold (S860: YES), the notification unit 150 outputs an alarm (S830). On the other hand, if the STJ value does not exceed the alarm threshold (S820: NO), the analysis unit 140 determines whether the Sgarbossa or Smith criteria are met (S840). If the Sgarbossa or Smith criteria are met (S840: YES), the notification unit 150 outputs a message (S850).

[0063] If it is determined in step S860 that the ST60 value does not exceed the alarm threshold (S860: NO), or if it is determined in step S840 that the ST60 value does not meet the Sgarbossa or Smith criteria (S840: NO), the process ends without any notification.

[0064] The above is an outline of the processing contents of each subroutine flowchart of the biological information processing device 100 in embodiment 1. To summarize the operation of the biological information processing device 100 in embodiment 1, the following processing is performed: the electrocardiogram waveform of the subject is measured and stored for a certain period of time, at least normal beats, atrial-paced beats, and ventricular-paced beats are grouped from the stored electrocardiogram waveform to create a representative waveform, ST measurement is performed on the created representative waveform, ST recall is registered, and an alarm or message is issued if the notification conditions are met. This processing makes it possible to monitor myocardial ischemia using ventricular-paced electrocardiogram waveforms, which was previously difficult to monitor.

[0065] [Embodiment 2] (Configuration of Biometric Information Processing Device) The configuration of the biometric information processing device of this embodiment is the same as the block diagram shown in FIG.

[0066] (Operation of biometric information processing device) The general operation of the biological information processing apparatus 100 according to this embodiment is the same as the processing shown in the main flowchart shown in FIG. 2. However, in this embodiment, the number of electrodes attached to the subject is 6, which is different from that in the first embodiment, and the obtained electrocardiogram waveform is 8. Therefore, in the step S100 in the main flowchart of FIG. 2, an 8-lead electrocardiogram waveform is measured, and in the step S200, the 8-lead electrocardiogram waveform is stored. Also, the processing of each subroutine flowchart of <ST measurement> in the step S600 and <Does it satisfy the notification condition?> in the step S800 is slightly different from that in the first embodiment. Hereinafter, the processing of these subroutine flowcharts will be described.

[0067] <ST measurement> FIG. 8 is a subroutine flowchart of the <ST measurement> step in the flowchart of FIG. 2 in the second embodiment. Note that the subroutine flowchart of FIG. 8 is applicable only to the second embodiment assuming 6 electrodes.

[0068] The ST measurement unit 130 determines the measurement reference point of the representative waveform created in the subroutine flowchart of <Create representative waveform> (see FIG. 3) (S610). In the case of this embodiment, the representative waveform is created for each lead of an 8-lead or 12-lead electrocardiogram waveform. The measurement reference point of the representative waveform is the ISO point or J point shown in the electrocardiogram waveform of FIG. 16. Note that the ISO point is the potential of the flat point at the start of the QRS (the start point of the Q wave), and the J point is the potential of the inflection point of the curve from the S wave to the T wave.

[0069] Next, the ST measurement unit 130 measures the shape of the representative waveform (S620). The shape of the representative waveform is not obtained qualitatively, but is, for example, characteristic values of each part of the representative waveform obtained quantitatively, such as the STJ value, ST60 value, QRS main peak amplitude, etc. shown in the electrocardiogram waveforms of FIGS. 15 and 16. Note that the STJ value is the potential of the J point, the ST60 value is the potential 60 msec behind the J point, and the QRS main peak amplitude is the potential with respect to the baseline of the highest point among the Q wave, R wave, and S wave.

[0070] Next, the ST measurement unit 130 determines whether the representative waveform is ventricular pacing (S630). If the representative waveform is ventricular pacing (S630: YES), it performs a determination based on the Sgarbossa criteria for each lead (S640) and a determination based on the Smith criteria for each lead (S650), and outputs the representative waveform, measurement reference point, STJ value, STJ / QRS main peak amplitude, whether the Sgarbossa criteria are met, and whether the Smith criteria are met for each lead to the analysis unit 140 (S660).

[0071] The ST measurement unit 130 calculates the total Sgarbossa score and the total Smith score for all leads (S670), and outputs the total Sgarbossa score and the total Smith score (S680). Note that the process of determination based on the Sgarbossa criterion and the process of determination based on the Smith criterion will be described later.

[0072] On the other hand, if the representative waveform is not ventricular pacing (S630: NO), the representative waveform, measurement reference point, STJ value, and ST60 value for each lead are output to the analysis unit 140 (S690).

[0073] <Judgment based on Sgarbossa's criteria> Fig. 9 is a subroutine flowchart of the step <Determination based on Sgarbossa's criterion> in the flowchart of Fig. 8 in embodiment 2. Note that the subroutine flowchart of Fig. 9 is applied to embodiments 2 and 3 assuming 6 or 10 electrodes.

[0074] The analysis unit 140 determines whether the QRS of the representative waveform is in the positive direction (S641), as shown in Figures 15 and 16. That is, as shown in Figures 15 and 16, it determines whether the change in QRS is in the upward direction (positive direction) or downward direction.

[0075] If the QRS is in the positive direction (S641: YES), the analysis unit 140 then determines whether the STJ elevation is 0.1 mV or more (S642). If the STJ elevation is 0.1 mV or more (S642: YES), the analysis unit 140 sets the Sgarbossa score to 5 (S643).

[0076] On the other hand, if the QRS is not in the positive direction (S641: NO), the analysis unit 140 next determines whether the STJ elevation is 0.5 mV or more (S644). If the STJ elevation is 0.5 mV or more (S644: YES), the analysis unit 140 sets the Sgarbossa score to 3 (S645).

[0077] If the STJ elevation is not 0.5 mV or more (S644: NO), the system determines whether the STJ descent is 0.1 mV or more in lead V1, V2, or V3 (S646). The range of STJ descent in lead V1, V2, or V3 can be set within a certain range using the operation unit 170 (see FIG. 1), similar to the Sgarbossa / Smith threshold shown in FIG. 22. The setting range is from 0.10 mV to 1.00 mV in increments of 0.01 mV, with an initial value of 0.1. The setting range can also be set as a distance (mm) on the ECG waveform graph instead of voltage. In this case, the setting range is from 1.0 mm to 10.0 mm in increments of 0.1 mm, with an initial value of 1.0. If the STJ descent is 0.1 mV or more (S646: YES), the Sgarbossa score is set to 2 (S647).

[0078] If the STJ elevation is not 0.1 mV or more in step S642 (S642: NO), or if the STJ depression is not 0.1 mV or more in leads V1, V2, or V3 (S646: NO), the Sgarbossa score is set to 0 (S648).

[0079] <Judgment based on Smith's criteria> Fig. 10 is a subroutine flowchart of the step <Determination based on Smith's criteria> in the flowchart of Fig. 8 in embodiment 2. Note that the subroutine flowchart of Fig. 10 applies to embodiments 2 and 3 which assume 6 or 10 electrodes.

[0080] The analysis unit 140 determines whether the STJ change is 0.1 mV or more and the STJ change / QRS main peak amplitude exceeds 0.25, as shown in Figures 15 and 16 (S651). The upper limit of the STJ / QRS amplitude ratio can be set in increments of 0.01 within the range of 01.0 to 1.00, as shown in the STJ / QRS alarm in Figure 21. Alternatively, the STJ / QRS alarm can be turned off. If the STJ change is 0.1 mV or more and the STJ change / QRS main peak amplitude exceeds 0.25 (S651: YES), the Smith score is set to 1 (S652).

[0081] On the other hand, if the STJ change is not 0.1 mV or more and the STJ change / QRS main peak amplitude is not greater than 0.25 (S651: NO), it is determined whether the QRS is moving in the positive direction (S653). That is, as shown in Figures 15 and 16, it is determined whether the QRS is moving in the upward (positive) direction or the downward direction.

[0082] If the QRS is in the positive direction (S653: YES), the analysis unit 140 then determines whether the STJ elevation is 0.1 mV or more (S654). If the STJ elevation is 0.1 mV or more (S654: YES), the analysis unit 140 sets the Smith score to 1 (S652).

[0083] On the other hand, if the QRS is not in the positive direction (S653: NO), the analysis unit 140 then determines whether the STJ descent is 0.1 mV or more in lead V1, V2, or V3 (S655). If the STJ descent is 0.1 mV or more (S6555: YES), the analysis unit 140 sets the Smith score to 1 (S652).

[0084] If the STJ elevation is not 0.1 mV or more in step S654 (S654: NO), and if the STJ depression is not 0.1 mV or more in leads V1, V2, or V3 (S655: NO), the Smith score is set to 0 (S656).

[0085] <Determine whether notification conditions are met> Fig. 11 is a subroutine flowchart of the step <Determine whether notification conditions are met> in the flowchart of Fig. 2 in embodiment 2. Note that the subroutine flowchart of Fig. 11 applies only to embodiment 2 which assumes six electrodes.

[0086] The ST measurement unit 130 determines whether the representative waveform created in the subroutine flowchart of <Create Representative Waveform> (see FIG. 3) is ventricular pacing (S810). If the representative waveform is ventricular pacing (S810: YES), the analysis unit 140 then determines whether the STJ value of any lead exceeds the alarm threshold (S820).

[0087] As shown in FIG. 20, the upper and lower limits of the STJ value alarm can be set within a certain range using the operation unit 170 (see FIG. 1). The setting range is in 0.01 mV increments, with the upper limit from −1.99 mV to +2.00 mV and the lower limit from −2.00 mV to +1.99 mV. The upper and lower limit settings can also be turned off. The setting range can also be set as a distance in mm on the electrocardiogram waveform graph instead of voltage. In that case, the setting range is in 0.1 mm increments, with the upper limit from −19.99 mm to +20.0 mm and the lower limit from −20.0 mm to +19.99 mm. The upper and lower limit settings can also be turned off.

[0088] If the STJ value of any lead exceeds the alarm threshold (S820: YES), the notification unit 150 outputs an alarm (S830). On the other hand, if the representative waveform is not ventricular pacing (S810: NO), the analysis unit 140 then determines whether the ST60 value of any lead exceeds the alarm threshold (S860). Note that, as shown in FIG. 19, the upper and lower limits of the ST60 alarm can be set within a certain range using the operation unit 170 (see FIG. 1). The setting range is in 0.01 mV increments, with the upper limit from −1.99 mV to +2.00 mV and the lower limit from −2.00 mV to +1.99 mV. The upper and lower limit settings can also be turned off. The setting range can also be set as a distance in mm on the electrocardiogram waveform graph instead of voltage, in which case the setting range is in 0.1 mm increments, with the upper limit from -19.9 mm to +20.0 mm and the lower limit from -20.0 mm to +19.9 mm. The upper and lower limit settings can also be turned off.

[0089] If the ST60 value of any lead exceeds the alarm threshold (S860: YES), the notification unit 150 outputs an alarm (S830). On the other hand, if the STJ value of any lead does not exceed the alarm threshold (S820: NO), the analysis unit 140 determines whether Sgarbossa's score is 3 or more or Smith's score is 1 or more (S840). If Sgarbossa's score is 3 or more or Smith's score is 1 or more (S840: YES), the notification unit 150 outputs a message (S850).

[0090] If it is determined in step S860 that the ST60 value of any lead does not exceed the alarm threshold (S860: NO), or if it is determined in step S840 that the Sgarbossa score is not 3 or more or the Smith score is not 1 or more (S840: NO), the process ends without any notification.

[0091] The above is the schematic processing content of each subroutine flowchart of the biological information processing apparatus 100 in Embodiment 2. Summarizing the operation of the biological information processing apparatus 100 in Embodiment 2, the electrocardiogram waveform of the subject is measured and stored until a certain period of time has elapsed, and from the stored electrocardiogram waveform, at least normal beats, atrial pacing beats, and ventricular pacing beats are grouped for each induction to create a representative waveform. ST measurement is performed on the representative waveform created for each induction, ST recall is registered, and if the notification condition is satisfied, an alarm or message is notified. By this processing, it becomes possible to monitor myocardial ischemia for the electrocardiogram waveform of ventricular pacing, which was conventionally difficult to monitor. Note that even in the case of Embodiment 2, if the chest leads are V1 and V2, it is possible to determine a left leg block.

[0092] [Embodiment 3] (Configuration of Biological Information Processing Apparatus) The configuration of the biological information processing apparatus of this embodiment is the same as the block diagram shown in FIG. 1.

[0093] (Operation of Biological Information Processing Apparatus) The schematic operation of the biological information processing apparatus 100 of this embodiment is the same as the processing shown in the main flowchart shown in FIG. 2. However, in this embodiment, the number of electrodes attached to the subject is 10, which is different from that in Embodiment 1 or 2, and the obtained electrocardiogram waveform is 12. Therefore, in step S100 in the main flowchart of FIG. 2, the electrocardiogram waveforms of 12 leads are measured, and in step S200, the electrocardiogram waveforms of 12 leads are stored. Also, the processing of each subroutine flowchart of <ST measurement> in step S600 and <Does it satisfy the notification condition?> in step S800 is slightly different from that in Embodiment 1. Hereinafter, the processing of these subroutine flowcharts will be described.

[0094] <ST measurement> FIG. 12 is a subroutine flowchart of the <ST measurement> step of the flowchart of FIG. 2 in Embodiment 3. Note that the subroutine flowchart of FIG. 12 is applicable only to Embodiment 3 assuming 10 electrodes.

[0095] The ST measurement unit 130 determines the measurement reference point of the representative waveform created in the subroutine flowchart of <create representative waveform> (see FIG. 3) (S610). In the case of this embodiment, the representative waveform is created for each lead of the 12-lead electrocardiogram waveform. The measurement reference point of the representative waveform is the ISO point or J point shown in the electrocardiogram waveform of FIG. 16. Note that the ISO point is the potential of the flat point at the start of the QRS complex (the start point of the Q wave), and the J point is the potential of the inflection point of the curve from the S wave to the T wave.

[0096] Next, the ST measurement unit 130 measures the shape of the representative waveform (S620). The shape of the representative waveform is not determined qualitatively, but is, for example, characteristic values of each part of the representative waveform determined quantitatively, such as the STJ value, ST60 value, QRS main peak amplitude, etc., shown in the electrocardiogram waveforms of FIGS. 15 and 16. Note that the STJ value is the potential of the J point, the ST60 value is the potential 60 msec behind the J point, and the QRS main peak amplitude is the potential based on the baseline of the highest point among the Q wave, R wave, and S wave.

[0097] Next, the ST measurement unit 130 determines whether the representative waveform is ventricular pacing or left bundle branch block (S630). If the representative waveform is ventricular pacing or left bundle branch block (S630: YES), for each lead, the determination based on the Sgarbossa criterion (S640) and the determination based on the Smith criterion (S650) are performed, and for each lead, the representative waveform, measurement reference point, STJ value, STJ / QRS main peak amplitude, presence or absence of compliance with the Sgarbossa criterion, and presence or absence of compliance with the Smith criterion are output to the analysis unit 140 (S660).

[0098] The ST measurement unit 130 calculates the total Sgarbossa score and the total Smith score for all leads (S670), and outputs the total Sgarbossa score and the total Smith score (S680). The processes of the judgment based on the Sgarbossa criterion and the judgment based on the Smith criterion are the same as those in the subroutine flowcharts shown in Figures 9 and 10.

[0099] On the other hand, if the representative waveform is not ventricular pacing or left bundle branch block (S630: NO), the representative waveform, measurement reference point, STJ value, and ST60 value for each lead are output to the analysis unit 140 (S690). <Judgment based on Sgarbossa's criteria> The subroutine flowchart of the step of "Determination based on Sgarbossa's criteria" in the flowchart of FIG. 12 in this embodiment is the same as that shown in FIG. <Judgment based on Smith's criteria> The subroutine flowchart of the step of "Determination based on Smith's criteria" in the flowchart of FIG. 12 is the same as that shown in FIG.

[0100] FIG. 13 is a subroutine flowchart of the <Determination of left bundle branch block> in the step <Is the representative waveform ventricular pacing or left bundle branch block?> of the flowchart in FIG.

[0101] The ST measurement unit 130 determines whether the QRS width as shown in FIG. 15 is greater than 120 msec (S631). If the QRS width is greater than 120 msec (S631: YES), it then determines whether lead V1 is an rS type or a QS type (S632). An rS type in lead V1 refers to an electrocardiogram waveform as shown on the left side of FIG. 17, and a QS type in lead V1 refers to an electrocardiogram waveform as shown on the right side of FIG. 17. Next, if lead V1 is an rS type or a QS type (S632: YES), it determines whether lead V6 is an R type (S633). An R type in lead V6 refers to an electrocardiogram waveform as shown in FIG. 18. If lead V6 is an R type (S633: YES), it then determines whether the R peak from the QRS origin in lead V6 is greater than 50 msec (S634). If the R peak from the QRS origin in lead V6 is greater than 50 msec (S634: YES), it is determined that the patient has left bundle branch block (S635).

[0102] On the other hand, if the QRS width is not greater than 120 msec (S631: NO), or lead V1 is not an rS or QS type (S632: NO), or lead V6 is not an R type (S633: NO), or the R peak from the QRS origin in lead V6 is not greater than 50 msec (S634: NO), it is determined that there is no left bundle branch block (S636).

[0103] <Determine whether notification conditions are met> FIG. 14 is a subroutine flowchart of the step <Determine whether notification conditions are met> in the flowchart of FIG. 2 in the third embodiment.

[0104] The ST measurement unit 130 determines whether the representative waveform created in the subroutine flowchart of <Create Representative Waveform> (see FIG. 3) is ventricular pacing or left bundle branch block (S810). If the representative waveform is ventricular pacing or left bundle branch block (S810: YES), the analysis unit 140 then determines whether the STJ value of any lead exceeds the alarm threshold (S820).

[0105] As shown in FIG. 20, the upper and lower limits of the STJ value alarm can be set within a certain range using the operation unit 170 (see FIG. 1). The setting range is in 0.01 mV increments, with the upper limit from −1.99 mV to +2.00 mV and the lower limit from −2.00 mV to +1.99 mV. The upper and lower limit settings can also be turned off. The setting range can also be set as a distance in mm on the electrocardiogram waveform graph instead of voltage. In that case, the setting range is in 0.1 mm increments, with the upper limit from −19.99 mm to +20.0 mm and the lower limit from −20.0 mm to +19.99 mm. The upper and lower limit settings can also be turned off.

[0106] If the STJ value of any lead exceeds the alarm threshold (S820: YES), the notification unit 150 outputs an alarm (S830). On the other hand, if the representative waveform is not ventricular pacing or left bundle branch block (S810: NO), the analysis unit 140 then determines whether the ST60 value of any lead exceeds the alarm threshold (S860). Note that, as shown in FIG. 19, the upper and lower limits of the ST60 alarm can be set within a certain range using the operation unit 170 (see FIG. 1). The setting range is in 0.01 mV increments, with the upper limit from −1.99 mV to +2.00 mV and the lower limit from −2.00 mV to +1.99 mV. The upper and lower limit settings can also be turned off. The setting range can also be set as a distance in mm on the electrocardiogram waveform graph instead of voltage, in which case the setting range is in 0.1 mm increments, with the upper limit from -19.9 mm to +20.0 mm and the lower limit from -20.0 mm to +19.9 mm. The upper and lower limit settings can also be turned off.

[0107] If the ST60 value of any lead exceeds the alarm threshold (S860: YES), the notification unit 150 outputs an alarm (S830). If the STJ value of any lead does not exceed the alarm threshold (S820: NO), the analysis unit 140 determines whether Sgarbossa's score is 3 or more or Smith's score is 1 or more (S840). If Sgarbossa's score is 3 or more or Smith's score is 1 or more (S840: YES), the notification unit 150 outputs a message (S850).

[0108] If it is determined in step S860 that the ST60 value of any lead does not exceed the alarm threshold (S860: NO), or if it is determined in step S840 that the Sgarbossa score is not 3 or more or the Smith score is not 1 or more (S840: NO), the process ends without any notification.

[0109] The above is an outline of the processing contents of each subroutine flowchart of the biological information processing device 100 in embodiment 3. To summarize the operation of the biological information processing device 100 in embodiment 3, the following processing is performed: the electrocardiogram waveform of the subject is measured and stored for a certain period of time, at least normal beats, atrial paced beats, ventricular paced beats, and left bundle branch block beats are grouped for each lead from the stored electrocardiogram waveform to create representative waveforms, ST measurement is performed for the representative waveform created for each lead, ST recall is registered, and an alarm or message is issued if the notification conditions are met. This processing makes it possible to monitor myocardial ischemia using electrocardiogram waveforms of ventricular pacing or left bundle branch block, which was previously difficult to monitor.

[0110] Next, notification of an alarm or message related to myocardial ischemia by the biological information processing device 100 of the present invention will be described. Notification of an alarm or message related to myocardial ischemia is performed audibly or visually by the notification unit 150 (see FIG. 1). Specific examples of visual notification, i.e., display, by the notification unit 150 are shown in FIGS. 23 and 24. The specific examples of display shown in these figures are common to embodiments 1 to 3. The specific examples of this display will be described below.

[0111] 23 is a diagram showing specific examples of ST values ​​and ST recall waveforms. As the analysis results of the ST measurement, the notification unit 150 displays the representative waveform created by the determination unit 120 and the measurement value (ST value 0.05 mV) related to the shape of the electrocardiogram waveform on the screen of the notification unit 150, as shown in FIG.

[0112] Because the interpretation of ST values ​​differs between ventricular pacing and left bundle branch block, the notification unit 150 devise a way to display ST recall. Specifically, the border of the ST recall waveform is given a gradation according to the ST value, and typically, the color simply becomes darker the further the ST value is from 0. That is, the border of the ST recall waveform shown in FIG. 23 becomes darker the larger the ST value. In addition to darkening the border, the border may also be made thicker or the color may change as the ST value increases. Furthermore, for ventricular pacing and left bundle branch block, a change in the direction opposite to the QRS may be treated the same as 0 until it exceeds 0.5 mV (or 1 / 4 of the QRS amplitude), and the color may begin to change once it exceeds 0.5 mV (or 1 / 4 of the QRS amplitude).

[0113] Fig. 24 is a diagram illustrating the display format of ST recall. As shown in Fig. 24, the analysis results of ST measurement can be displayed in various formats on the screen of the notification unit 150. For example, ST recall has a function for comparing a waveform registered as a reference with a waveform at any time. For this reason, two types of references, "normal beat reference" and "ventricular pacing reference," or two types of references, "normal beat reference" and "left bundle branch block reference," can be registered, allowing the user to select which one they want to view.

[0114] For this reason, the notification unit 150 has a function of selectively switching the electrocardiogram waveform of a normal beat, a ventricular pacing beat, or a left bundle branch block beat on the screen, and the notification unit 150 also has a function of registering the electrocardiogram waveform of a normal beat, a ventricular pacing beat, or a left bundle branch block beat.

[0115] As shown in FIG. 24, the screen of the notification unit 150 has a guidance name display field 151, a sensitivity display field 152, a reference display field 153, a reference registration field 154, a reference switching field 155, a check box 156, a comment display mark 157, a cursor frame 158, a scroll field 159, and a display operation field 161.

[0116] The lead name display field 151 indicates which lead the ST recall displayed to the right of this field pertains to. For example, in the first embodiment, three electrodes are attached to the subject, so only one lead is displayed. However, in the second or third embodiment, six or ten electrodes are attached to the subject, so eight or twelve leads are displayed. In FIG. 24, four leads are displayed, but to display other leads, the scroll section 159 is slid. In the case of eight leads, the other four leads not shown in FIG. 24 can be displayed by sliding the scroll section 159. In the case of 12 leads, the other eight leads not shown in FIG. 24 can be displayed by sliding the scroll section 159. Furthermore, the lead to be displayed can be changed by touching the lead name displayed in the lead name display field 151.

[0117] The ST recalls for each lead are displayed in chronological order from left to right at regular intervals (for example, every 5 minutes). In Figure 24, the ST recalls registered over a 25-minute period are displayed in chronological order.

[0118] The display sensitivity can be changed by touching the sensitivity display field 152. In Fig. 24, the display sensitivity is set to 1.

[0119] The reference display field 153 displays either a normal beat or a ventricular paced beat registered by operating the reference registration unit 154. The presence of the reference display field 153 makes it easy to compare either a normal beat or a ventricular paced beat displayed in the reference display field 153 with the ST recall waveform displayed in chronological order to the right of this field.

[0120] By operating this portion, the reference registration unit 154 registers the ST recall selected by the cursor frame 158 as a reference.

[0121] The reference switching unit 155 allows the user to select a desired reference from among the multiple types of references registered in the reference registration unit 154 by switching between them.

[0122] Checkboxes 156 are used to select files to record and print. Comment display marks 157 are displayed when comments have been entered. Cursor frame 158 is used to specify the file to be registered as a reference. Scroll unit 159 can be slid to display ST recalls of guided trials that are not displayed on the screen. Display operation unit 161 can be used to split the screen or display full screen, switch to another review screen, and set the display time interval for ST recalls.

[0123] The biometric information processing device, the biometric information processing method, and the control program for the biometric information processing device of the present invention have been described in detail above based on the embodiments. However, the technical scope of the biometric information processing device, the biometric information processing method, and the control program for the biometric information processing device of the present invention is not limited to the contents of the embodiments described above. [Explanation of symbols]

[0124] 100 Biometric information processing device 110 electrodes 120 Judgment section 122 Heart rate detector 124 Pulse detection unit 126 Heart rate determination unit 130 ST measurement unit 140 Analysis Department 150 Notification Department 151 Guide name display field 152 Sensitivity display field 153 Reference display column 154 Reference Registration Section 155 Reference switching section 156 Checkboxes 157 Comment display mark 158 Cursor Frame 159 Scroll section 160 Analysis control section 161 Display operation section 170 Operation section 180 Storage section

Claims

1. a determination unit that determines from an electrocardiogram waveform of a subject that the electrocardiogram waveform corresponds to at least one of a ventricular pacing beat and a left bundle branch block beat; an ST measurement unit that performs ST measurement by applying an evaluation criterion for myocardial ischemia to the determined electrocardiogram waveform; an analysis unit that analyzes the results of the ST measurement and outputs the analysis results and information related to myocardial ischemia audibly or visually; having The determination unit determines an electrocardiogram waveform corresponding to a ventricular pacing beat from the subject's electrocardiogram waveform when the number of electrodes attached to the subject is three or six, and determines an electrocardiogram waveform corresponding to a ventricular pacing beat and an electrocardiogram waveform corresponding to a left bundle branch block beat from the subject's electrocardiogram waveform when the number of electrodes attached to the subject is ten.

2. A determination unit that determines from a subject's electrocardiogram waveform that the electrocardiogram waveform corresponds to at least one of a ventricular pacing beat and a left bundle branch block beat; an ST measurement unit that performs ST measurement by applying an evaluation criterion for myocardial ischemia to the determined electrocardiogram waveform; an analysis unit that analyzes the results of the ST measurement and outputs the analysis results and information related to myocardial ischemia audibly or visually; having the ST measurement unit performs ST measurement by applying a determination based on at least one of the Sgarbossa criteria and the Smith criteria to the determined electrocardiogram waveform and a measurement value related to the shape of the electrocardiogram waveform determined to be a ventricular pacing beat or a measurement value related to the shape of the electrocardiogram waveform determined to be a left bundle branch block beat as an evaluation criterion for myocardial ischemia; When the number of electrodes attached to the subject is three, the ST measurement unit makes a determination based on the Sgarbossa criteria and the Smith criteria by determining whether or not the electrocardiogram waveform determined to be a ventricular pacing beat conforms to the Sgarbossa criteria and the Smith criteria, and when the number of electrodes attached to the subject is six or ten, makes a determination based on the Sgarbossa criteria and the Smith criteria by determining whether or not the electrocardiogram waveform determined to be a ventricular pacing beat conforms to the Sgarbossa criteria and the Smith criteria which are different from the case where the number of electrodes is three. a determination based on the Sgarbossa criteria and the Smith criteria depending on the score obtained by comparing the Sgarbossa criteria and the Smith criteria when the number of electrodes attached to the subject is 10, and a determination based on the Sgarbossa criteria and the Smith criteria depending on the score obtained by comparing the Sgarbossa criteria and the Smith criteria when the number of electrodes attached to the subject is 6, the Sgarbossa criteria and the Smith criteria when the score obtained by comparing the Sgarbossa criteria and the Smith criteria when the number of electrodes attached to the subject is 6 is the same as that of the Sgarbossa criteria and the Smith criteria when the number of electrodes attached to the subject is 6.

3. 3. The biological information processing device according to claim 2, wherein the ST measurement unit, when the number of electrodes attached to the subject is 6 or 10, determines the scores of the Sgarbossa criteria and the Smith criteria for the electrocardiogram waveform of the ventricular pacing beat or the left bundle branch block beat in each lead and calculates a total score for all leads, thereby making a judgment based on the Sgarbossa criteria and the Smith criteria.

4. 4. The biological information processing device according to claim 3, wherein the ST measurement unit uses at least a measurement reference point (ISO point, J point), an STJ value, and an STJ / QRS main peak amplitude of the electrocardiogram waveform as measurement values ​​related to the shape of the electrocardiogram waveform when performing ST measurement.

5. 5. The bioinformation processing device according to claim 4, wherein the analysis unit outputs an alarm when the STJ value exceeds a set alarm threshold, and outputs a message when the STJ value meets the Sgarbossa criteria or the Smith criteria even if the STJ value does not exceed the set alarm threshold.

6. 5. The bioinformation processing device according to claim 4, wherein the analysis unit outputs an alarm when the STJ value of any lead exceeds a set alarm threshold when the number of electrodes attached to the subject is 6 or 10, and outputs a message when the total score of the Sgarbossa criteria or the Smith criteria exceeds a set total score even if the STJ value of any lead does not exceed the set alarm threshold.

7. 7. The biological information processing apparatus according to claim 1, further comprising a notification unit that notifies the user of the analysis result output by the analysis unit and an alarm or message related to myocardial ischemia.

8. 8. The biological information processing device according to claim 7, wherein the determination unit classifies the electrocardiogram waveform of the subject into electrocardiogram waveforms corresponding to at least one of ventricular pacing beats and left bundle branch block beats, creates a group of ventricular pacing beats or a group of left bundle branch block beats, and determines that the electrocardiogram waveform corresponds to at least one of ventricular pacing beats and left bundle branch block beats using a representative waveform created from the group of ventricular pacing beats or the group of left bundle branch block beats.

9. 9. The biological information processing device according to claim 8, wherein the determination unit determines an average waveform created from a plurality of electrocardiogram waveforms in a group of ventricular pacing beats as a representative waveform of the ventricular pacing beats, or determines an average waveform created from a plurality of electrocardiogram waveforms in a group of left bundle branch block beats as a representative waveform of the left bundle branch block beats.

10. The biological information processing device according to claim 8 , wherein the notification unit displays, on a screen, a measurement value relating to the shape of the representative waveform and the electrocardiogram waveform created by the determination unit as an analysis result of the ST measurement.

11. The biological information processing device according to claim 10 , wherein the notification unit has a function of selectively switching an electrocardiogram waveform displayed on a screen between a normal beat, a ventricular pacing beat, and a left bundle branch block beat.

12. The biological information processing device according to claim 11 , wherein the notification unit has a function of registering an electrocardiogram waveform of a normal beat, a ventricular pacing beat, or a left bundle branch block beat.

13. The biological information processing device according to claim 12 , wherein the notification unit displays a frame line of a displayed electrocardiogram waveform so that the frame line becomes darker as the ST value of the electrocardiogram waveform increases.

14. A determination unit that determines whether an electrocardiogram waveform of a subject corresponds to at least one of a ventricular pacing beat and a left bundle branch block beat from the electrocardiogram waveform of the subject; an ST measurement unit that performs ST measurement by applying an evaluation criterion for myocardial ischemia to the determined electrocardiogram waveform; an analysis unit that analyzes the results of the ST measurement and outputs the analysis results and information related to myocardial ischemia audibly or visually; having The determination unit classifies the electrocardiogram waveform of the subject into a group of normal beats, a group of atrial pacing beats, and a group of ventricular pacing beats or left bundle branch block beats, and when there is no group of normal beats and no group of atrial pacing beats and there is a group of ventricular pacing beats or left bundle branch block beats, determines that the electrocardiogram waveform corresponds to at least one of ventricular pacing beats and left bundle branch block beats using a representative waveform created from the group of ventricular pacing beats or left bundle branch block beats.

15. The bioinformation processing device of claim 14, wherein the judgment unit classifies the subject's electrocardiogram waveform into a normal beat group, an atrial pacing beat group, and a ventricular pacing beat group or a left bundle branch block beat group based on the presence or absence of a pacing pulse and the shape of the subject's electrocardiogram waveform.

16. A method for operating a biological information processing device that enables monitoring of myocardial ischemia from electrocardiogram waveforms even when the electrocardiogram waveforms are those of ventricular pacing or left bundle branch block, comprising: a step of determining by the biological information processing device that an electrocardiogram waveform of the subject corresponds to at least one of a ventricular pacing beat and a left bundle branch block beat; a step of performing ST measurement by the biological information processing device by applying an evaluation criterion for myocardial ischemia to the determined electrocardiogram waveform; a step in which the biological information processing device analyzes a result of ST measurement and outputs an analysis result and information related to myocardial ischemia audibly or visually; Including, A method for operating a bio-information processing device, in which, in the determining step, if the number of electrodes attached to the subject is three or six, an electrocardiogram waveform corresponding to a ventricular pacing beat is determined from the subject's electrocardiogram waveform, and if the number of electrodes attached to the subject is ten, an electrocardiogram waveform corresponding to a ventricular pacing beat and an electrocardiogram waveform corresponding to a left bundle branch block beat are determined from the subject's electrocardiogram waveform.

17. A method for operating a bioinformation processing device that enables monitoring of myocardial ischemia from electrocardiogram waveforms, even if the electrocardiogram waveforms are those of ventricular pacing or left bundle branch block, comprising: a step of determining by the biological information processing device that an electrocardiogram waveform of the subject corresponds to at least one of a ventricular pacing beat and a left bundle branch block beat; a step of performing ST measurement by the biological information processing device by applying an evaluation criterion for myocardial ischemia to the determined electrocardiogram waveform; a step in which the biological information processing device analyzes a result of ST measurement and outputs an analysis result and information related to myocardial ischemia audibly or visually; Including, In the step of performing ST measurement, ST measurement is performed by applying a determination based on at least one of the Sgarbossa criteria and the Smith criteria to the determined electrocardiogram waveform and a measurement value related to the shape of the electrocardiogram waveform determined to be a ventricular pacing beat or a measurement value related to the shape of the electrocardiogram waveform determined to be a left bundle branch block beat as an evaluation criterion for myocardial ischemia; In the step of performing the ST measurement, when the number of electrodes attached to the subject is three, a judgment is made based on the Sgarbossa criteria and the Smith criteria by judging whether or not the electrocardiogram waveform determined to be a ventricular pacing beat conforms to the Sgarbossa criteria and the Smith criteria, and when the number of electrodes attached to the subject is six or ten, a judgment is made based on the Sgarbossa criteria and the Smith criteria by judging whether or not the electrocardiogram waveform determined to be a ventricular pacing beat conforms to the Sgarbossa criteria and the Smith criteria which are different from the case where the number of electrodes is three. a judgment is made based on the Sgarbossa criteria and the Smith criteria depending on the score obtained by comparing the Sgarbossa criteria and the Smith criteria when the number of electrodes attached to the subject is 10, and a judgment is made based on the Sgarbossa criteria and the Smith criteria depending on the score obtained by comparing the Sgarbossa criteria and the Smith criteria when the number of electrodes attached to the subject is 6, the Sgarbossa criteria and the Smith criteria being the same as the score obtained by comparing the Sgarbossa criteria and the Smith criteria when the number of electrodes attached to the subject is 6.

18. A control program for a biological information processing device that enables monitoring of myocardial ischemia from electrocardiogram waveforms even when the electrocardiogram waveforms are those of ventricular pacing or left bundle branch block, comprising: A computer that functions as the bioinformation processing device, a determination unit that determines from an electrocardiogram waveform of a subject that the electrocardiogram waveform corresponds to at least one of a ventricular pacing beat and a left bundle branch block beat; an ST measurement unit that performs ST measurement by applying an evaluation criterion for myocardial ischemia to the determined electrocardiogram waveform; an analysis unit that analyzes the results of the ST measurement and outputs the analysis results and information related to myocardial ischemia audibly or visually; and make it work. A control program for a bioinformation processing device, wherein the determination unit determines an electrocardiogram waveform corresponding to a ventricular pacing beat from the subject's electrocardiogram waveform when the number of electrodes attached to the subject is three or six, and determines an electrocardiogram waveform corresponding to a ventricular pacing beat and an electrocardiogram waveform corresponding to a left bundle branch block beat from the subject's electrocardiogram waveform when the number of electrodes attached to the subject is ten.

19. A control program for a bioinformation processing device that enables monitoring of myocardial ischemia from electrocardiogram waveforms, even if the electrocardiogram waveforms are those of ventricular pacing or left bundle branch block, comprising: A computer that functions as the bioinformation processing device, a determination unit that determines from an electrocardiogram waveform of a subject that the electrocardiogram waveform corresponds to at least one of a ventricular pacing beat and a left bundle branch block beat; an ST measurement unit that performs ST measurement by applying an evaluation criterion for myocardial ischemia to the determined electrocardiogram waveform; an analysis unit that analyzes the results of the ST measurement and outputs the analysis results and information related to myocardial ischemia audibly or visually; and make it work. the ST measurement unit performs ST measurement by applying a determination based on at least one of the Sgarbossa criteria and the Smith criteria to the determined electrocardiogram waveform and a measurement value related to the shape of the electrocardiogram waveform determined to be a ventricular pacing beat or a measurement value related to the shape of the electrocardiogram waveform determined to be a left bundle branch block beat as an evaluation criterion for myocardial ischemia; When the number of electrodes attached to the subject is three, the ST measurement unit judges whether the electrocardiogram waveform judged to be a ventricular pacing beat conforms to the Sgarbossa criteria and the Smith criteria, thereby making a judgment based on the Sgarbossa criteria and the Smith criteria, and when the number of electrodes attached to the subject is six or ten, the ST measurement unit judges whether the electrocardiogram waveform judged to be a ventricular pacing beat conforms to the Sgarbossa criteria and the Smith criteria which are different from the case where the number of electrodes is three. a determination based on the Sgarbossa criteria and the Smith criteria depending on the score obtained by comparing an electrocardiogram waveform determined to be a left bundle branch block beat with an electrocardiogram waveform determined to be a ventricular pacing beat when the number of electrodes attached to the subject is 10 and a determination based on the Sgarbossa criteria and the Smith criteria depending on the score obtained by comparing an electrocardiogram waveform determined to be a ventricular pacing beat with an electrocardiogram waveform determined to be a ventricular pacing beat when the number of electrodes is 6.

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