Method for predicting functional myocardial state and its adaptation capacity in elderly and senile patients

FIELD: medicine, cardiology.

SUBSTANCE: in male patients of elderly and senile age one should register electrocardiogram and its first derivative in 12 leads to evaluate the rate of ventricular activation. In case of this rate being below 34.9 one should evaluate high degree of lethality risk. The method enables to detect the risk for availability of complex cardiac rhythmic disorders more rapidly and non invasively in case of exacerbation of bronchoobstructive diseases.

EFFECT: higher efficiency of diagnostics.

4 ex, 1 tbl

 

The invention relates to medicine, in particular to geriatric cardiology, and can be used for diagnostics of the functional state of the myocardium, its adaptive capacities of the patients of elderly and senile age with cardiovascular diseases.

Electrocardiography remains one of the main methods of diagnosis of the functional state of the myocardium. However, electrocardiographic study does not provide reliable pathognomonic symptoms. Interpretation of many of ECG changes in old age is difficult (Korkushko O.V. Geriatric aspects of cardiovascular disease. - Heart disease and blood vessels, Ed. Chazov E.I. M.: Medicine. - 1992. - V.4. - P.5-33).

There are other diagnostic methods of choice in the diagnosis of the functional state of the myocardium, in particular echocardiography. But these methods do not allow to assess the reserve of adaptive capacity in the aging process.

The closest to the technical essence and the achieved effect to the claimed method and selected as a prototype method is non-invasive diagnostics of disorders of adaptation processes in the heart, where the calculated speed indicators electrical activity of the heart - rate activation of the ventricles (SOOT) as the average of the private division of the amplitude of the largest is ubca in 12 standard leads of the first derivative of the ECG to the amplitude of the normal ECG (Volkova AG Abstracts of the III regional conference of doctors therapists. - Chelyabinsk, 1972, p.34-36).

A new approach to the evaluation of functional state of the myocardium in patients of elderly and senile age with cardiovascular disease in contrast to traditional ECG studies gives the opportunity to quantify the magnitude of the rate of change of the electrical activity of the myocardium, which is a marker of status changes of cell membranes, triggering mechanism of the adaptive ability of the heart in patients of elderly and senile age.

The main task of the present invention is the provision of opportunities for assessment of functional state of the myocardium and its adaptive capacity in the aging process.

The technical result of the invention is the introduction and wide use in cardiology method for estimating the rate of activation of the ventricles as a marker of the functional state of the myocardium.

The specified task according to the invention is implemented by examining the speed of activation of the ventricles of the heart using ECG and its first derivative and is characterized by the fact that appreciate the value of the rate of change of the electrical activity of the myocardium and SOOT<34,9 define a high risk of death.

Conducted research on patentrim and scientific and technical information sources showed that the proposed with whom persons unknown in geriatric cardiology and meets the criteria of "novelty" and "inventive step".

The proposed method can be applied in any hospital equipped with standard equipment.

Thus, the inventive method is readily available, highly sensitive, non-invasive and practically applicable.

The proposed method allows the diagnostics of functional state of the heart, its adaptive capacities and can be recommended for mass prevention programs in population and epidemiological studies, i.e meets the requirements for screening.

This technique is performed as follows. Patient is placed in a horizontal position and remove the ECG and 1 derived 12-lead with any of the electrocardiograph and electronic console with a time constant of 0,0075, which was based on the method of analog-to-digital conversion of the ECG circuit. The value of the SOOT is defined as the average value of the ratio of the maximum amplitude of the corresponding curve of the normal QRS complex of the ECG.

We conducted a survey of high-speed determinants of the electrical activity of the heart in 164 men elderly and senile age with cardiovascular disease (mean age 75.4 years).

Table No. 1

The speed of activation of the ventricles/td>
 the group of patientsonly
age, years60-69 n=2470-79 n=9280-92 n=4860-92 n=164
 1234
CHD42,1+-0,5 n=2040,3+-0,5 n=8340,5+-1,0 n=4340,9+-0,9 n=146
CHD PEAK36,4+-1,7 n=1039,1+-0,5* n=3136,6+-0,9 n=637?4+-0?8 n=47
*P2-3<0,05
CHD without PEAK43,9+and-0.6 n=1040,9+-0,5* n=5141,2+-0,8 n=3742,0+a-0.7 n=98
*P1-2<0,001
Without CHD41,6+-0,3 n=443,2+-0,3** n=941,6+and-0.6 n=542,1+-1,0 n=18
*P1-20,05;**P2-3<0,001.

With increasing age there is a decrease in indices of SOOT. In all age groups in CHD patients received lower levels of SOOT in comparison with the same indicators in patients without CHD (p<0,001). The most pronounced decrease in SOOT identified in CHD patients with postinfarction cardiosclerosis reliable in all age groups (p<0,05). With an increase in functional class circulatory failure absorption is possible in all age groups is set to decrease in SOOT.

To explore the functional relationships calculated correlation coefficients between the amount of SOOT and the following indicators : age, number of diseases, total serum cholesterol, alpha-cholesterol, triglycerides, fibrinogen, CRP, number of T-lymphocytes in patients with CAD and without CAD.

Table No. 2

Correlation coefficients speed activation of the ventricles
 CHDwithout CHD
Age-0,114-0,126
the number of diseases-0,278-0,193
SLO-0,349-0,209
Cholesterol-0,288-0,133
triglycerides-0,021-0,001
alpha-cholesterol+0,582+0,389
T-lymphocytes+0,379+0,215
fibrinogen-0,229-0,121

Correlation wore a direct one between the value of the SOOT and the level of alpha-cholesterol, the number of T-lymphocytes, reversed between the amount of SOOT and age, CRP, cholesterol, and fibrinogen. The closest relationship was observed between dormancy is the result SOOT and alpha-cholesterol, the number of T-lymphocytes, CRP and was weak between indicators of SOOT and cholesterol, fibrinogen, number of diseases, by age.

It is estimated that the number of deaths for the period 3-year prospective follow-up in the investigated group of patients, depending on the magnitude of the SOOT.

Table No. 3

The relative risk of death depending on the magnitude of the SOOT
 SOOT 40-49SOOT 35-39,9SOOT 30-34,9The SOOT to 29.9
The number of surveyed109241513
The number of person-years of follow-up327724539
The number of deaths3498
Died for 100 people2,716.660,061,5
Total mortality per 1000 person-years of follow-up9,255,5of 199, 9205,1
The relative risk 6,0321,722,3

Of the 24 patients with SOOT 35,0-39,9 died 4 (16.6%), and the relative risk of death was 6,03. Of the 15 patients with SOOT 30,0-34,9 died chelovek (60,0%), the relative risk of death was 21.7, of the 13 patients with less SOOT 29,9 died 8 people (61,5%), the relative risk of death was 22.3.

Thus, it is proposed to use the amount of SOOT as an integral indicator of the functional state of the myocardium in men middle-aged and elderly.

In clinical practice can be recommended determination of the SOOT to stratify risk. Persons having a value less SOOT 34,9 constitute a group at high risk, less 29,9 - very high risk.

Systematic analysis of the main indicators of the functioning of the heart in conjunction with other zhizneobespechivajushchimi processes allows better understanding the processes of adaptation and maladaptation during aging.

The method of determining the degree of risk of death in men elderly and senile age by assessing the functional state of the myocardium and its ability to adapt, which consists in the fact that, by registering the electrocardiogram and its first derivative in the 12 leads, assess the speed of activation of the ventricles, and at the speed of activation of the ventricles less 34,9 define a high risk of death.



 

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