Ischemic Cardiopathy Diagnosis with ECG-Guided Pressure Timing
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Solution Overview
Problem
Existing diagnostic techniques for ischemic cardiopathy, such as FFR and iFR, face challenges in accurately determining the pressure ratio Pd/Pa due to variations in intracoronary resistance values, which are influenced by myocardial motion and individual patient differences, especially when medications like adenosine are not administered.
Innovation Solution
A diagnosis assistance system that measures intracoronary pressures and incorporates local intracoronary electrocardiogram data to identify a stable period of low vascular resistance, allowing for precise calculation of the pressure ratio Pd/Pa between proximal and distal stenotic segments in coronary arteries.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If FFR measurement is performed by administering medication to reduce microvascular resistance, then the pressure ratio measurement becomes standardized, but patient safety risks increase and medication contraindications arise
Solution Approach 1:
The measurement period is segmented into specific phases (rapid filling phase, slow filling phase, ejection phase) based on the cardiac cycle and intracoronary ECG waveforms. This allows selection of the slow filling phase where vascular resistance is naturally low, eliminating the need for medication while maintaining measurement validity
Solution Approach 2:
Intracoronary ECG data serves as an intermediary to identify and select the appropriate measurement timing within the cardiac cycle. The ECG waveforms (P wave, QRS complex, T wave) act as markers to determine when vascular resistance is optimally low, replacing the need for pharmacological intervention
2Object-affected harmful factors
If iFR measurement is performed without medication during WFP period, then patient safety is maintained, but intravascular resistance may not be sufficiently reduced for accurate diagnosis
Solution Approach 1:
The system dynamically adapts the measurement timing to each patient's individual cardiac cycle characteristics by analyzing intracoronary ECG waveforms. The measurement period is adjusted based on actual myocardial motion patterns rather than using a fixed WFP window, ensuring optimal resistance conditions are captured
Solution Approach 2:
The system uses intracoronary ECG feedback to continuously monitor myocardial electrical activity and adjust the measurement timing accordingly. The ECG waveforms provide real-time information about myocardial motion phases, allowing dynamic selection of the slow filling phase for measurement
3Adaptability or versatility
If pressure ratio is measured during variable cardiac phases, then individual patient differences are captured, but measurement consistency and reliability decrease
Solution Approach 1:
The system applies local quality by selecting specific phases within the cardiac cycle (slow filling phase) where the physiological conditions are most favorable for measurement. Rather than measuring throughout the entire cycle, it focuses on the localized period where myocardial motion is minimal and vascular resistance is consistently low
Solution Approach 2:
The system changes the measurement parameter from a fixed time window (as in iFR) to a dynamically determined period based on intracoronary ECG waveform analysis. This allows adaptation to individual patient rhythms while maintaining consistent measurement conditions by always selecting the slow filling phase
Data Source
AI summary
An ischemic cardiopathy diagnosis assistance system includes pressure data acquisition means 11 for acquiring pressure data including proximal pressure Pa in a proximal stenotic segment A1 and distal pressure Pd in a distal stenotic segment A2; intracoronary electrocardiogram data acquisition means 12 for acquiring intracoronary electrocardiogram data made up of a local intracoronary artery electrocardiogram in a neighborhood of the distal stenotic segment; and computational processing means 14 for finding a pressure ratio Pa/Pd between the proximal pressure Pa and distal pressure Pd at a time suitable for diagnosis of ischemic cardiopathy based on these data. The computational processing means temporally associates the pressure data with the intracoronary electrocardiogram data, estimates an analysis period T during which vascular resistance remains stably low from a waveform of the intracoronary electrocardiogram data, and extract the pressure data of the analysis period T, and finds the pressure ratio Pa/Pd from the pressure data.