Summary of Contents for Itamar Medical EndoPATx System
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6322515, 6461305, 6488633, 6916289, 6939304, 7374540, as well as any pending US patent applications and corresponding patents and/or applications filed in other countries. EndoPAT , EndoScore™ and PAT™ are trademarks of Itamar Medical, Ltd. Copyright 2019-2024 by Itamar Medical Ltd.
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LICENSE AGREEMENT IS PROHIBITED. DISCLAIMER Itamar Medical Ltd. shall not be held responsible in any manner for any bodily injury and/or property damage arising from operation or use of this device other than that which adheres to the instructions and safety precautions contained herein and in all supplements...
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Itamar Medical Ltd. Itamar Medical Ltd. Itamar Medical Ltd. Record of Revisions Record of Revisions Record of Revisions Revision Revision Date Date Description Description Chapter Chapter Pages Pages Revision Date Description Chapter Pages 26 Aug 2019 26 Aug 2019 Initial release...
Itamar Medical Ltd. Table of Contents General Information ............. 1 Intended Use of the EndoPAT x Device ..........1 Performance and clinical study information ........... 1 Equipment Classification ............... 3 Manufacturers Notice ................3 Restrictions for Use ................3 Quality Assurance System: EN ISO 13485..........4 Conventions Used in this Manual ............
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Itamar Medical Ltd. Conducting an EndoPAT x Study ........46 Pre-Study .................... 46 Patient and System Setup..............48 Performing the Study ................50 Review and Analysis ............53 Study Data Retrieval ................53 Automatic Analysis ................53 Study Report ..................54 EndoPAT x study results ..............
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Itamar Medical Ltd. List of Figures Figure 1 – Typical Setup of EndoPAT™x Study ............10 Figure 2 – EndoPAT™x System ................... 11 Figure 3 - Knob for USB Cable ..................12 Figure 4 - Login Screen ....................16 Figure 5 - Local admin pull down menu ............... 17 Figure 6 - List of Users ....................
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Itamar Medical Ltd. Figure 32 - Search Patient ..................... 35 Figure 33 - Search Button List of Patients ..............35 Figure 34 - Patient Record – Doctor View ..............36 Figure 35 – Patient Record – Doctor View: Single Study Review Options ....36 Figure 36 - Patient Record –...
Itamar Medical Ltd. 1 General Information This operation manual is part of the EndoPAT x system. Intended Use of the EndoPAT x Device The EndoPAT x device is a non-invasive device, intended for use as a diagnostic aid in the detection of coronary artery Endothelial Dysfunction (positive or negative) using a reactive hyperemia procedure.
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Itamar Medical Ltd. The Gold Standard for Endothelial Dysfunction evaluation, the Intra-coronary Acetylcholine (Ach) Challenge method, is routinely performed at the Mayo Clinic. According to the Intra-coronary Acetylcholine (Ach) Challenge method, a catheter is positioned in the origin of the left main coronary artery and Ach is infused with incremental concentration followed by coronary angiogram.
The information in this document is subject to change without notice. Itamar Medical Ltd. makes no warranty of any kind on this material, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. Itamar Medical Ltd.
The device is intended for diagnostic aid purposes only and should not be used for • Itamar Medical Ltd. makes no representation whatsoever, that the act of reading this Itamar Medical Ltd. makes no representation whatsoever, that the act of reading this monitoring.
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Itamar Medical Ltd. Itamar Medical Ltd. Itamar Medical Ltd. STANDARD STANDARD STANDARD Graphical symbols for electrical equipment in medical IEC/TR 60878 Graphical symbols for electrical equipment in medical Graphical symbols for electrical equipment in medical IEC/TR 60878 IEC/TR 60878 practice...
Itamar Medical Ltd. Conventions Used in this Manual The following conventions are used throughout this manual: Warnings Are used to identify conditions or actions, which - if the instructions are ignored - may violate patient safety, or could cause damage/malfunction of the system, resulting in the irretrievable loss of data.
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Itamar Medical Ltd. Use of an inappropriate cable may cause irreparable damage to the device and may compromise patient safety or electro-magnetic compliance. WARNING The EndoPAT x device should only be installed with and connected to computer equipment that complies with IEC 60950-1 or IEC 62368-1.
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The system contains no user-serviceable parts. It should be maintained and serviced only by qualified service personnel, authorized by Itamar Medical Ltd. Purchasers of the EndoPAT x device should ensure that only suitably trained, qualified personnel are authorized to operate the equipment.
Itamar Medical Ltd. 2 System Overview The EndoPAT x device is a computer-based system for non-invasively assessing vascular ™ endothelial dysfunction. It is based on the use of Peripheral Arterial Tone (PAT ) signal technology, during a clinically established procedure, which measures post-ischemic vascular responsiveness following upper arm blood flow occlusion.
Itamar Medical Ltd. Itamar Medical Ltd. 3 Installing the System 3 Installing the System Basic System Configuration Basic System Configuration The EndoPAT x device is supplied as a The EndoPAT x device is supplied as a complete package comprising the following...
Itamar Medical Ltd. Itamar Medical Ltd. System description System description The EndoPAT The EndoPAT x device front panel has the following indicators (see Figure 2 – x device front panel has the following indicators (see Figure 2 – Itamar Medical Ltd.
Itamar Medical Ltd. Connecting the EndoPAT x device to the computer NOTE The EndoPAT x system requires the use of a USB cable (supplied with the system) for connecting to the computer. 1. Place the EndoPAT x device and computer on a stable platform in close proximity to the examination bed or chair.
Itamar Medical Ltd. EndoPAT x Software Installation NOTE Prior to software installation, verify that you are in full system administrator mode with full privileges. Otherwise, the installation might not succeed and could cause operational problems. 1. Close all open applications operating on the computer, including background applications, before installing the EndoPAT x software.
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Itamar Medical Ltd. 9. When screen appears press “No” (don’t confirm restart!) 10. When the below screen appears click on “Summary” 11. Then you should see “Itamar EPx was successfully installed” 12. Click on the small arrow on the right corner and choose “Quit”...
Itamar Medical Ltd. Uninstalling EndoPAT x Software Use the EndoPAT x install wizard to uninstall the application from your PC. Shutting Down the System a. Shut down the EndoPAT x software program by clicking on the “X” on the upper right corner.
Itamar Medical Ltd. 4 EndoPAT x Application Description The following screens describe the full application. Viewer mode has the relevant subset of the controls (the title of the screen might be different). EndoPAT x User Roles There are three user roles for the EndoPAT...
Itamar Medical Ltd. Once logged in as Local Admin press on the arrow on upper right side of the screen. A pull- down menu will open with optional tasks (Figure 5 - Local admin pull down menu). Figure 5 - Local admin pull down menu Select Users, a list of existing users will appear and an option to Create Users.
Itamar Medical Ltd. NOTE The system does not send an automatic email to the user, the Local Admin should provide the name and password to each user created. Operator – Patient Management Screens 4.3.1 Search for an existing patient Figure 8 - Search/Create Patient Enter the patient’s name or identifier (ID).
Itamar Medical Ltd. Figure 9 - Selecting Name/ID From List Figure 10 - Search Button List Selecting a patient either from the drop-down list or Search results opens the Patient Record. 4.3.2 Add New Patient To add a new Patient, click on the “+ Add new patient” button.
Itamar Medical Ltd. Figure 12 - New Patient When form is filled, click “Save and Continue” button to open Patient Record screen. 4.3.3 Patient Record Screen - Operator The Patient Record Screen displays the personal details and risk factors (optional). In addition, Previous Test Records can be accessed through this link.
Itamar Medical Ltd. 4.3.3.1 Update/Edit Patient details. Clicking on UPDATE on the personal details sections opens the following pop-up window. Click Apply to update the details and return to the Patient Records screen. Figure 14 - Edit/Update Patient Info. Note Patient ID cannot be modified and updated.
Itamar Medical Ltd. 4.3.3.3 Access previous patient EndoPAT x test records. To access previous Patient EndoPAT x test records, click on Previous Test Records in Patient information and new Study window (Figure 13). Figure 18 - List of Previous Studies...
Itamar Medical Ltd. Itamar Medical Ltd. Itamar Medical Ltd. Figure 19 - Previous Study Options Figure 19 - Previous Study Options Figure 19 - Previous Study Options 4.3.3.4 View Signal 4.3.3.4 View Signal 4.3.3.4 View Signal Selecting View Signal will open the previous study and enable the auto analysis of the data.
Itamar Medical Ltd. 4.3.3.5 Export Selecting the Export option from the Previous Study option (Figure 19) will create a file that can be imported to another EndoPAT x system (Figure 21 below) Figure 21 - Exported EndoPAT x File 4.3.3.6 View Report Selecting View Report will create an automated report in HTML format.
Itamar Medical Ltd. Conducting EndoPAT x Study – Operator The Test section of the screen (Figure 13) is used to finalize new study information and initiate an EndoPAT x Study. Please note that to initiate a new test, the EndoPAT device must be turned on and connected.
Itamar Medical Ltd. 4.4.2 EndoPAT x Study - Main Screen Figure 26 - New Study Screen The main screen of EndoPAT x study includes the following main sections: • System stability o Indication of leakage detection • PAT Signal Waveform Viewer...
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Itamar Medical Ltd. o Stop the study in middle of test if needed. o Navigation between study stages o Inflate and Deflate buttons for patient setup 4.4.3 Standby Stage Once probes are properly connected (see section Preparation of fingers and hands...
Itamar Medical Ltd. When Baseline Stage timer reaches the recommended time, the Occlusion Stage icon becomes enabled ( ) allowing the transition to Occlusion Stage. Baseline recommended time is 6 minutes. Just before end of Baseline stage and before inflation of the blood pressure cuff, press the Max Gain button on the designated occluded signal.
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Itamar Medical Ltd. Occlusion Stage timer ( ) is displayed, displaying time elapsed since the stage started and the recommended time for this stage. If stage elapsed time exceeds the recommended time, a “+” sign is displayed before the timer.
Itamar Medical Ltd. Figure 28 - End of Study Comment 4.4.7 Post-test study screen and automated analysis. Insert comments if needed and Press Save and Continue. The Patient file will be displayed on the screen. Figure 29 - Study Screen...
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Itamar Medical Ltd. 4.4.8 Stopping the Study At any point during the study, you may click on the Stop Test button ( This will automatically release the air pressure and deflate the probes. Stopping a test at any point after “Standby” will stamp the probes as “used” and new probes should be attached if restarting the study.
Itamar Medical Ltd. 4.4.9 Warning and Error Indications When an unwanted system condition is detected, the user is provided with error / warning indication at the bottom of the screen. Figure 30 - Error Indicator Clicking on either error tooltip or error indication open the following error report:...
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Itamar Medical Ltd. Symbol Severity Sever error condition that impacts study execution Minor/moderate error condition that might impact study execution if not handled in timely manner The time in which the error condition was detected is indicated. Endo PAT x Device...
Itamar Medical Ltd. Reviewing the EndoPAT x Study – Doctor (Reviewer) This section is applicable only to a user with the Doctor role. 4.5.1 Locating EndoPAT x Study for review Figure 32 - Search Patient Enter the patient’s name or identifier (ID). The system automatically displays the drop-down list of patients that match the entered name / ID.
Itamar Medical Ltd. Figure 34 - Patient Record – Doctor View Clicking on a specific study will open the following pop-up screen Figure 35 – Patient Record – Doctor View: Single Study Review Options Single study review includes the following options: •...
Itamar Medical Ltd. 4.5.2.2 Patient Record – Patient View The Patient Record, Patient View (Figure 36) displays the graphs of results and medical indices of a single patient. For discussion on the RHI (Reactive Hyperemia Index) score, please refer to section 7.2. Note that the Other Medical Indices do not affect the RHI score calculation and are entered manually by the operator.
Itamar Medical Ltd. • PAT Signal Waveform Viewer o Display the acquired PAT signals from Probe A and B o Separate gain control for each signal o Study stage bookmarks o Time scale zoom o Timeline marker • Editing Toolbar...
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NOTE To enable the Manual Analysis functions, it is necessary to enable the Manual Research Mode by Itamar Medical technician 4.5.5.1 Marking Segments and Artifacts Tool bar icons provide quick and easy access to the tools used to mark segments and artifacts in research studies, as well as to facilitate automatic ratio calculations between PAT™...
Itamar Medical Ltd. Figure 38 – Manual Research Mode Analysis and Signal View Screen 4.5.5.2 Analysing PAT™ Ratios NOTE After the B and T segments are marked, their PAT™ ratios can be Calculated segment ratios displayed in the left side calculated by clicking T/B icon and of the screen do not have clinical implication.
Itamar Medical Ltd. 4.5.6 Printing EndoPAT x Study Report Select the Print option on the browser to print the study report. Figure 39 - Print Report Through Browser Menu Endo PAT x Device Operation Manual...
Itamar Medical Ltd. 5 Preparing for a Study Preparing the System for a Study Accessories that are required beside the EndoPAT x system: A set of two PAT probes and anchors • Blood pressure cuff (capable of sustaining high pressures for 5 minutes) •...
Itamar Medical Ltd. Figure 42 - Press to release Figure 43 - Probe disconnected Creating/Updating Patient’s Record 1 Search for existing Patient (4.3.1) or create a new patient record (4.3.2). 2 Update or enter current patient details as follows: All mandatory fields are marked with asterisk and must be filled to proceed to the next step.
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Itamar Medical Ltd. NOTE All text fields should be entered using text letters and numbers. 3 Enter/update Patient’s Risk Factors - Select the risk factor method (Framingham Risk Score, European Risk Scoreor Reynolds Risk Score) and fill in the additional inputs required to calculate Cardio-vascular Risk Factor.
Itamar Medical Ltd. Required in Parameter Remark Framingham Reynolds European Gender* Taken from the patient information main dialog box Systolic blood pressure* Table 1 – Risk Factors mandatory fields * Parameters that are used in the calculation of the Risk but are part of the main Patient Information Dialog and not the Risk Factors Dialog.
Itamar Medical Ltd. 6 Conducting an EndoPAT x Study Pre-Study WARNING Use the blood pressure cuff-set provided by Itamar Medical for arm occlusion. Usage of non-certified cuff- might compromise the results. 6.1.1 General description The EndoPAT system is comprised of a system console and two independent sensing probes coupled to connecting pneumo-electric tubing and foam finger mounting rings.
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Itamar Medical Ltd. The patient should then be comfortably seated or allowed to lie down in the study room and relax for at least 15 minutes or a sufficient period to reach a relaxed cardiovascular steady- state and to adjust to the room temperature.
Itamar Medical Ltd. Patient and System Setup 6.2.1 Study conditions The study should be conducted in a quiet and relaxed atmosphere. Phones, beepers, and other devices which can cause startling noises should be turned off; otherwise, the startle effect on the patient might affect the test result.
Itamar Medical Ltd. Figure 44 - Applying the PAT™ probes Make sure the tubing forms a loop from the probe, back to the anchor as shown in Figure 44. The patient should be instructed to refrain from moving the fingers to the extent possible.
Itamar Medical Ltd. Performing the Study NOTE Do not change the time or date of the computer during the study. Changing the windows time while recording might result in corrupted study. 6.3.1 Recording baseline Click the STANDBY icon, from the main screen. The system will display the signals from the two PAT™...
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Itamar Medical Ltd. NOTE While in the Standby mode, data is not recorded. Click the BASELINE icon to begin study recording. 6.3.2 Performing arterial occlusion After a stable period of the required baseline signal recording (5-6min.), prepare for the occlusion: 1.
Itamar Medical Ltd. Left – complete occlusion Right – incomplete occlusion In both panels the bottom signal is the occluded arm. Figure 46 - Occlusion quality assessment 6.3.3 Post Occlusion period When exactly five minutes have passed, deflate the pressure cuff as quickly as possible.
Itamar Medical Ltd. 7 Review and Analysis During a PAT™ study, recorded signals are viewed in the display window, based on the appearance of the traces, a qualitative evaluation can be performed. However, subsequent review of the study using the special features described in this chapter facilitates a quantitative analysis of the acquired data.
Itamar Medical Ltd. The HR (Heart Rate) is calculated from the PAT™ signals in the baseline region of interest. 7.2.1 Manual Correction of the Occlusion Borders Click the magic wand to create the automatic analysis borders. Select the occlusion borders as follow: Once automatic analysis is performed (see 4.5.4.1), Occlusion bookmarks are displayed on...
Itamar Medical Ltd. This transformation is a monotonic transformation; therefore, it does not change the dichotomous diagnosis (normal/abnormal) for any individual test. LnRHI provides a better double-sided distribution that is very close to normal distribution (Gaussian) in its nature. The histograms of RHI and LnRHI (based on the analysis of large...
Itamar Medical Ltd. The graph presents the distribution function of the LnRHI in the non-selected population. The data used is composed of nearly 10,000 data points collected from different study cohorts worldwide. The mean / median LnRHI in the population (0.7, marked in blue) and the dichotomy threshold for normal endothelial function (0.51, marked in red) are presented as vertical lines...
Itamar Medical Ltd. AI in the EndoPAT™ is calculated from the PAT™ pulses at the base-line period of the occluded arm, by averaging multiple valid pulses and finding the systolic peak (P ) and the backward reflected peak (P ) and then using the formula: (P2-P1)/P1. See Figure 50.
Itamar Medical Ltd. particularly the balance between sympathetic and parasympathetic activities. Low HRV has been described as related to various pathological conditions. The EndoPAT™ HRV is calculated from the baseline period, based on the European Society of Cardiology and the North American Society of Pacing Electrophysiology task force standard.
Itamar Medical Ltd. Researchers that want to use this index for research purposes can ask Itamar Medical to enable this index as part of the registration process. Study printing You can print the displayed data at any time during off-line review and analysis by selecting the Print option through Windows pull down menu.
Only qualified medical personnel should use this equipment. In the event of equipment malfunction all repairs should be executed by qualified Itamar Medical personnel or authorized service agents. Maintenance instructions should be followed closely to avoid unnecessary equipment failure or potential health hazards to the user or patient.
Itamar Medical Ltd. Itamar Medical Ltd. Itamar Medical Ltd. 9 Troubleshooting 9 Troubleshooting 9 Troubleshooting Description Possible Cause Action Description Description Possible Cause Possible Cause Action Action • Switch on the EndoPAT x device. • • Switch on the EndoPAT Switch on the EndoPAT x device.
Itamar Medical Ltd. Itamar Medical Ltd. Itamar Medical Ltd. Description Possible Cause Action Description Description Possible Cause Possible Cause Action Action ™ • Replace PAT probe. ™ ™ • • Replace PAT Replace PAT probe. probe. Faulty probe. Faulty probe.
Itamar Medical Ltd. System Error Messages The following table provides a list of system error messages that the user may encounter when running the analysis. Some of the errors may be corrected after proper manual occlusion marking (if the errors are caused by a wrong automatic detection of the occlusion borders).
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AllocationMemory or Program Failure i.e. System software problems that prevents the program NoCorrPulse to complete the analysis (call Itamar Medical customer support). BT_MajorBreakThrough Meaning incomplete occlusion. The amount of blood flow detected during the occlusion period is too high, i.e. there are measured pulses during the occlusion in the occluded hand.
AllocationMemory or Program Failure i.e. System software problems that prevents the program NoCorrPulse to complete the analysis (call Itamar Medical customer support). BT_MajorBreakThrough Meaning incomplete occlusion. The amount of blood flow detected during the occlusion period is too high, i.e. there are measured pulses during the occlusion in the occluded hand.
Itamar Medical Ltd. 10 Technical Information 10.1 System Minimum Requirements ® An IBM or compatible PC with dual core processor 1.4 GHZ CPU or higher Internet browsers Chrome version 70, Edge version 44, Firefox version 63 or above versions 8.00 GB RAM, Windows 10 64 bits...
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Itamar Medical Ltd. Directive) and related standards. The product is marked with the CE logo. Use-by date Single use, do not re-use Temperature limit Medical device Manufacturer Catalogue Number Serial Number According to the WEEE Directive 2012/19/EU, all waste electrical and electronic equipment (EEE) should be collected separately and not disposed of with regular household waste.
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Itamar Medical Ltd. The product is certified by TUV Rheinland UDI code: The Unique Device Identification System is intended to assign a unique identifier to medical devices Endo PAT x Device Operation Manual...
Itamar Medical Ltd. 10.4 Labeling 10.4.1 System Label The System Label is located at the bottom of the EndoPAT x device: 10.4.2 Power Rating Label The Power Rating Label is located near the power inlet connector of the EndoPAT device: 10.4.3 Applied Part Label...
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Itamar Medical Ltd. 10.4.4 Packaging labels The following labels are attached to the master package of the EndoPAT x system: Endo PAT x Device Operation Manual...
Itamar Medical Ltd. 10.5 Specifications of EndoPAT x system Properties Description PAT™ Probe Itamar Medical’s proprietary probe only Recording Time Limited by hard disk space, ~35MB per study of 20 minutes Indications 3 LED’s - power, communication, error PAT™ Channel 1÷...
The document can be viewed at https://www.itamar-medical.com/wp-content/uploads/2020/09/License-Agreement- 09.2020.pdf Should you have any questions concerning this License Agreement, or if you desire to contact Itamar Medical for any reason, please write to: USA: Itamar Medical Inc. 3290 Cumberland Club Drive, Suite 100...
Itamar Medical Ltd. Appendix B: Regulatory Authorized Representative Arazy Group GmbH The Squaire 12, Am Flughafen, 60549 Frankfurt am Main, Germany Endo PAT x Device Operation Manual...
The use of accessories other than those specified or sold by Itamar Medical as replacement • The use of accessories other than those specified or sold by Itamar Medical as replacement The use of accessories other than those specified or sold by Itamar Medical as replacement •...
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Itamar Medical Ltd. Table 2 - from IEC 60601-1-2:2014 Guidance and manufacturer's declaration – electromagnetic immunity – EndoPAT x (EPX) The EDx is intended for use in the electromagnetic environment specified below; The customer or the user of the EPX should assure that it is used in such an environment.
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Itamar Medical Ltd. Itamar Medical Ltd. Itamar Medical Ltd. Table 3 - from IEC 60601-1-2:2014 Table 3 - from IEC 60601-1-2:2014 Table 3 - from IEC 60601-1-2:2014 Guidance and manufacturer's declaration – electromagnetic immunity – EndoPAT x (EPX) Guidance and manufacturer's declaration – electromagnetic immunity – EndoPAT Guidance and manufacturer's declaration –...
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Itamar Medical Ltd. Table 4 - from IEC 60601-1-2:2014 Recommended separation distances between portable and mobile RF communications equipment and the EndoPAT TM x The EPX is intended for use in the electromagnetic environment specified below; The customer or the user of the EPX should assure that it is used in such an environment.
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Itamar Medical Ltd. Itamar Medical Ltd. Itamar Medical Ltd. Test Test Test Band a) Band a) Band a) Service a) Service a) Service a) Modulation Modulation Modulation Maximum Maximum Maximum Distance Distance Distance Immunity Immunity Immunity Compliance Compliance Compliance frequency...
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Itamar Medical Ltd. Itamar Medical Ltd. Itamar Medical Ltd. Table 5 - Test specifications for ENCLOSURE PORT IMMUNITY to RF wireless communications equipment Table 5 - Test specifications for ENCLOSURE PORT IMMUNITY to RF wireless communications equipment Table 5 - Test specifications for ENCLOSURE PORT IMMUNITY to RF wireless communications equipment...
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Itamar Medical Ltd. Itamar Medical Ltd. Itamar Medical Ltd. Recommended Separation Distances Recommended Separation Distances Recommended Separation Distances The EndoPAT The EndoPAT x is intended for use in an electromagnetic environment in which radiated x is intended for use in an electromagnetic environment in which radiated...
Itamar Medical Ltd. APPENDIX D: SPARE PARTS LIST The following items can be ordered and purchased individually: Pneumatic PAT Probe (a box of 12 probes) Pneumo-electric tubing Set of 30 foam finger anchors Accessories Kit Power Cable USB cable EndoPAT...
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