Screening diagnostic technique for heart diseases

FIELD: medicine.

SUBSTANCE: 12-lead electrocardiogram (ECG) is recorded. That is followed by measuring the ECG parameters: R wave amplitude in the aVL lead, S and R waves amplitudes in the V4 lead, Q wave and ST segment amplitudes and R wave length in the V5 lead, patient's Quetelet index; f(z) is calculated by the presented formula derived by mathematical statistics methods. If f(z) is 0.35 or more, the presence of at least one heart disease specified in left ventricular dilatation, lower ejection fraction, disturbed regional contractility, left ventricular aneurism, ventricular septum thickening, thickening of a left ventricular posterior wall.

EFFECT: method enables increasing the early detection of heart diseases at mass health examinations by observing specific ECG parameters.

2 ex

 

The invention relates to medicine, namely to cardiology, and can be used in functional diagnostics, including at the stage of mass medical examinations.

Medical examination - a type of survey to assess the health status of the population. The purpose of medical examinations is a dynamic monitoring of the health status of patients, prevention and early identification of early signs of diseases.

Effect of mass screening and orientation of a medical examination shall not include costly or prolonged diagnostic procedures. Electrocardiography (ECG) because of its low cost, rapidity and simplicity and noninvasiveness and safety for the patient is the main instrumental method of assessment of the cardiovascular system applied at the stage of screening (although the readings may be assigned and more complex methods in-depth survey).

One of the methods in-depth examination of the patients is ultrasound of the heart - echocardiography (EchoCG), which allows to identify organic and functional pathology of the heart by visualization of a beating heart. Echocardiography is highly informative, has no contraindications, but compared with ECG Echocardiography significantly more missed�e and are expensive.

Known non-invasive method for early diagnostics of functional state of the myocardium in patients with arterial hypertension (EN 2413460 C2, Zhavoronkova, E. Yu., etc., 26.01.2009), which includes registration of the electrocardiogram and its first derivative to determine the speed of activation of the ventricles of the heart. Values indicative of the rate of activation of the ventricles and the degree of arterial hypertension assess the decrease of functional reserves of the myocardium and its adaptive abilities. This method uses the first derivative of the ECG and can not be applied in practice clinics that are not equipped for electrocardiographs with the function of calculating the first derivative of the ECG. In addition, this method can only be used in patients with arterial hypertension and does not evaluate the morphological structure of the heart.

The known method of early diagnosis of cor pulmonale (EN 2192161 C2, Dimova, L. A., etc., 09.08.2000), which includes registration of values of the amplitude of teeth R and S standard electrocardiographic chest leads (V1-V6), heart rate and calculation of diagnostic indicator according to the original formula. However, this method allows to evaluate the presence of pulmonary heart, i.e. the increase and extension of the right departments of heart, and does not evaluate the left-side chambers.

Also known a method of electrocardiographic diagnostics� pulmonary heart (EN 2206263 C2, Varlamov N. G. and Evdokimov, V. G., 27.09.2002), which includes registration 12-lead ECG, measurement of the number of ECG parameters (the amplitude of the P wave in lead II, the amplitude of Q in lead V6, the amplitude of the R wave in leads I-III, aVF, V1, V4-6, the amplitude of the wave S in leads I-II, VI, V5-6, the amplitude of the T wave in lead aVR, the duration of the P wave, segment P-Q and QRS complex in lead II), the calculation of several indicators, assessment in points and the calculation of the average score, which make the conclusion about the presence of the disease or the patient belongs to a risk group. However, this method requires measurement of a large number of parameters and allows to assess only the presence of cor pulmonale.

The described method electrocardiographic diagnosis of myocardial hypertrophy of the left ventricle in hypertensive patients with overweight (EN 2344754 C1, M. M. Saltykov and others, 16.07.2007). It includes ECG registration and analysis of the amplitude of waves of the QRS complex: the hypertrophy of the myocardium of the left ventricle for men diagnosed with SV4more than 1.1 mV or RaVL+SV3more than 2.3 mV, and for women at RaVLmore than 0.8 mV or RI+SIIImore than 1.5 mV. However, this method does not allow to assess the presence of other changes of heart and is only applicable in hypertensive patients with overweight.

The closest to potentialassets method for the diagnosis of hypertrophy of the right ventricle in patients with chronic obstructive bronchitis (EN 2216270 C1, Fedosova N. N. and Kravchenko A. I., 10.12.2003 - prototype), which includes registration of ECG, determination of the amplitude of indicators of teeth of the electrocardiogram RV1, SV5, TV1, TV2, S1, RaVR, RV1+SV5patient's age and duration of the disease and the diagnostic indicator calculating Z according to the original formula, the value of which is judged on the likelihood of the presence of right ventricular hypertrophy. This method does not allow to assess changes in other parts of the heart and can only be used in patients with chronic obstructive bronchitis.

The present invention is directed to solving the task of screening diagnosis of heart disease according to the information extracted from the ECG, can be used at the stage of mass medical examinations.

Method of screening diagnosis of heart disease includes registration of the electrocardiogram in 12 leads.

The difference is that define the ECG parameters: the amplitude of the R wave in lead aVL, waves amplitudes S and R in lead V4, the amplitude of the Q and ST-segment and the duration of the R wave in lead V5, body mass index, diastolic blood pressure of the patient, calculate the index of f(z) by the formula:

,

where-z=12,333-0,057·X1-0,132·X2-1,796·X3+2,106·X4-

-0,07·X7+12,122·X5+7,215·X6+0,003·(-100·X8/X4),

g�e X 1- age, years; X2- body mass index, diastolic blood pressure; X3- the amplitude of the R wave in lead aVL, mV; X4- the amplitude of the wave S in lead V4, mV; X5- the range of Q in lead V5, mV; X6- the amplitude of the ST segment in lead V5, mV; X7- the duration of the R wave in lead V5, MS; X8- the amplitude of the R wave in lead V4, mV, and when the value of f(z) of greater than or equal to 0.35, diagnose the presence of at least one of heart disease from the list containing the dilation of the left ventricle, decreased ejection fraction, impaired regional contractility, an aneurysm of the left ventricle, thickening of the interventricular septum, thickening of the posterior wall of the left ventricle.

The technical result consists in increasing the reliability of screening.

For a preliminary assessment of the condition of the heart at the stage of screening used the constructed decision rule that identifies patients with heart disease. Authenticity confirmed by echocardiography, because it has a high sensitivity and specificity. The use of rules will allow to conduct Echocardiography to suggest the possible findings and make decisions about which of the patients should be performed Echocardiography in the first place.

By results of check sliding exam sensitivity and specificity of the decision rule �leave respectively 80% and 77.6%.

According to the results of trial operation in KB No. 85 of FMBA of Russia in the study of outpatients with median age 53 years [37; 63], it was found that the sensitivity of the rule was 71% (95% CI 45%; 85%), whereas specificity was more than 89% (95% CI 70%; 99%). Thus, the constructed decision rule can be used to classify the state of the hearts of the workers in industries.

The method is implemented as follows. The patient, define the following parameters:

X1- age, years;

X2- body mass index, diastolic blood pressure (BMI);

X3- the amplitude of the R wave in lead aVL, mV;

X4- the amplitude of the wave S in lead V4, mV;

X5- the range of Q in lead V5, mV;

X6- the amplitude of the ST segment in lead V5, mV;

X7- the duration of the R wave in lead V5, MS;

X8- the amplitude of the R wave in lead V4, mV.

In this case the amplitude of teeth S and Q can take only negative values of the R wave is positive, and ST-segment both negative and positive. The values obtained are substituted in the formula [1].

where-z=12,333-0,057·X1-0,132·X2-1,796·X3+2,106·X4-

-0,07·X7+12,122·X5+7,215·X6+0,003·(-100·X8/X4).

If f(z) is greater than or equal to 0.35, the patient should be referred to the group with heart disease, confirm to the�gidemem echocardiography data,i.e. by echocardiography, patients will have discovered at least one of the following violations:

- dilatation of the left ventricle (KDR/height>3,3, RIC≥56 mm);

- reduced ejection fraction (<60%);

- violation of regional contractility, left ventricular aneurysm;

- thickening of the interventricular septum (for women>11 mm; for men>12 mm);

- thickening of the posterior wall of the left ventricle (>11 mm).

Listed below are clinical examples that matched the results obtained by the patented method, and the results of Echocardiography, which confirm the achievement of the technical result, namely improving the reliability of screening.

Example 1. Patient F., 56 years old, height 180 cm, weight 100 kg, the following indicators:

X1=56; X2=30,9; X3=0,85 mV; X4=-0,42 mV; X5=0,00 MB; X6=0.03 mV; X7=88 MS; X8=0,52 mW;

-z=12,333-0,057·56-0,132·30,9-1,796·0,85+2,106·(-0,42)-

-0,07·88+12,122·0,00+7,215·0,03+0,003·(-100·0,52/(-0,42))≈0,422,

Since f(z)=0,40 greater than the set threshold value of 0.35, the patient F. referred to the group of patients with lesions of the heart.

The study Echo the results obtained fully confirmed. Observed akinesia all front and peredneperegorodochnoj segments, hypokinesia the top, rear and bottom walls of the left ventricle; �altace left heart chambers; a decrease in the pumping and diastolic function of the left ventricle; mitral and papillary dysfunction; mitral regurgitation 2. aortic atherosclerosis; sealing of the aortic cusps, calicinet on on leaf no coronary stenosis.

Example 2. Patient R., 53 years old, height 153 cm, weight 53,

X1=53; X2=22,6; X3=043 mV; X4=-1,27 mV; X5=To -0.05 mV;

X6=0,04 mV; X7=39 MS; X8=1,55 MB.

-z=12,333-0,057·53-0,132·22,6-1,796·0,43+2,106-(-1,27)-

-0,07·39+12,122·(-0,05)+7,215·0,04+0,003·(-100·1,55/(-1,27))≈3,496,

Since f(z)=0.03 to less than the set threshold value of 0.35, the patient R. referred to the group of patients not suffering from heart disease.

When performing Echocardiography studies the results obtained fully confirmed: not found any of the signs of heart disease from the specified list. On Echocardiography, the decrease of the diastolic function of the left ventricle, the seal of the mitral cusps, prolapse of anterior mitral 4.7 mm, mitral regurgitation of 2 degrees of tricuspid regurgitation 1 degree, valve regurgitation pulmonary artery 1 degree, atherosclerosis of the aorta and the seal of the aortic cusps. However, these changes are not indicative of heart disease.

Method of screening diagnosis of heart disease, including registering�Yu electrocardiogram (ECG) in twelve leads, characterized in that the ECG to determine the amplitude of the R wave in lead aVL, waves amplitudes S and R in lead V4, the amplitude of the Q and ST-segment and the duration of the R wave in lead V5, determine the body mass index, diastolic blood pressure of the patient, calculate the index of f(z) by the formula:

where
-z=12,333-0,057·X1-0,132·X2-1,796·X3+2,106·X4-
-0,07·X7+12,122·X5+7,215·X6+0,003·(-100·X8/X4);
X1- age, years;
X2- body mass index, diastolic blood pressure;
X3- the amplitude of the R wave in lead aVL, mV;
X4- the amplitude of the wave S in lead V4, mV;
X5- the range of Q in lead V5, mV;
X6- the amplitude of the ST segment in lead V5, mV;
X7- the duration of the R wave in lead V5, MS;
X8- the amplitude of the R wave in lead V4, mV, and when the value f(z) of greater than or equal to 0.35, diagnose the presence of at least one of heart disease from the list containing the dilation of the left ventricle, decreased ejection fraction, impaired regional contractility, an aneurysm of the left ventricle, thickening of the interventricular septum, thickening of the posterior wall of the left ventricle.



 

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1 cl, 2 dwg, 2 ex, 4 tbl

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EFFECT: higher accuracy of evaluation.

2 ex

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