Method for determining risk of unfavourable clinical outcome in patients with idiopathic pulmonary hypertension

FIELD: medicine.

SUBSTANCE: method involves determining a period of time from the onset of symptoms to establishing a diagnosis (t); a functional class is rated at the time of establishing the diagnosis (FCinit); a cardiac output is calculated at the time of establishing the diagnosis (CO); an acute pharmacological test (APT) coefficient (X) is calculated as follows: (APT-)=0, (APT+)=1, (APT++)=2. A risk of the unfavourable clinical outcome in the patients suffering from idiopathic pulmonary hypertension (H) is calculated by an original formula. If the value H ≤0.35, a low risk is stated; H=0.36-0.55 shows a moderate risk, whereas H≥0.56 is a sign of a high risk of the unfavourable clinical outcome.

EFFECT: method enables the high-reliability detection of the unfavourable clinical outcome in the patients with idiopathic pulmonary hypertension, the determination of rates of the disease progression for the purpose of prescribing an adequate therapy.

2 ex

 

The invention relates to medicine, in particular to cardiology and pulmonology, and can be used to determine the risk of development of adverse outcome in patients with idiopathic pulmonary hypertension (ILG).

The known method of determining the degree of pulmonary hypertension by pulmonary artery catheterization with measurement of hemodynamic parameters in the system of the pulmonary circulation. When it is determined by increased pressure in the pulmonary artery (FOR), wedge pulmonary artery (JLA) may be normal or elevated. To determine the severity of pulmonary hypertension is calculated pulmonary vascular resistance (CRL) according to the formula of the wood:

CRL=(Design-ZLO)/SV,

where SV - cardiac output.

Pulmonary hypertension is considered to be easy, if the average is 2-5 UNITS, moderate - 5-10 U, heavy - more than 10 UNITS. (Demchuk V. A. Idiopathic pulmonary hypertension: news of medicine and pharmacy. Online edition / http://www.mif-ua.eom/archive/article/5185; date accessed 28.03.2014,)

The disadvantages of this method are that the determination of the degree of severity of the disease makes it impossible to determine the risk of adverse outcome.

There is also known a method of determining the risk of development of adverse outcome in patients with pulmonary hypertension. Conduct clinical and instrumental ... " �tion. The predictors of poor prognosis in pulmonary hypertension include high functional class, low tolerance during the test the 6-minute walk (6-MH) or cardiopulmonary load test, high right atrial pressure, significant right ventricular dysfunction, low cardiac index, high level of brain natriuretic peptide, cases of systemic diseases of the connective tissue. (Trichotoma Ε.L. Diagnosis and treatment of pulmonary hypertension: Medical news. - 2009. - No. 15. - P. 13-18.)

The disadvantage of this method is the subjectivity and low accuracy of determining the risk of development of adverse outcome.

The object of the invention is to provide an effective method for determining the risk of development of adverse outcome in patients with idiopathic pulmonary hypertension, allowing to reliably determine the rate of disease progression opportunities for the appointment of adequate therapy and increasing the survival rate of patients.

The technical result of the invention is to improve the efficiency of the method and the reduction in the number of adverse outcomes in patients with idiopathic pulmonary hypertension.

This is achieved in that in the claimed method of determining the risk of development of adverse outcome in patients with idiopathic pulmonary hypertension by �rovedine examination of the patient according to the invention determine the period from the onset of symptoms to diagnosis (t), define functional class at the time of diagnosis (FCRef), calculate the cardiac output at the time of diagnosis (SV), set the ratio (X) acute pharmacological tests (RPTS), which corresponds to the value:

(FUC-)=0, (FUC+)=1, (RP++)=2, thus the risk of adverse outcome (H) is calculated by the formula:

Η=0,2×Exp(0,104×t+0,663×FCRef-0,519×SVRef-0,849×(X)OFP),

and the result with a value ≤0,35 define low risk, 0.36 to 0.55 to moderate risk, ≥0,56 - high risk of adverse outcome.

The method is as follows.

The patient carried out the examination using clinical and instrumental methods.

To determine the risk of development of adverse outcome idiopathic pulmonary hypertension use four parameters as independent prognostic factors: t - period from the onset of symptoms to diagnosis, FCRef- functional class at the time of diagnosis, SV - cardiac output at the time of diagnosis, the ratio of (X) the acute pharmacological test (OFP) corresponds to the value: if acute pharmacological test negative (RP-), set the value 0; if acute pharmacological test positive with one vasodilator (FUC+), set the value to 1; if� acute pharmacological test with two vasodilators (PCF++), set the value to 2.

The risk of unfavourable outcome (H) is calculated by the formula:

H=0.2×Exp(0,104×t+0,663×FCRef-0,519×SVRef-0,849×(X)OFP.

The calculated value of the forecast corresponds to the probability of unfavourable outcome in patients with ILG. The risk of an unfavourable outcome to assess each patient in accordance with the value: value ≤0,35 corresponds to low risk, 0.36 to 0.55 to moderate risk, ≥0,56 - high risk of adverse outcome.

Examples of the method

Example 1. The patient A. the time from debut to establish ILG was 2 years, the source FC - 3, STRef- 3, RP- (=0).

To calculate the risk of an unfavorable outcome, have a formula according to the claimed method:

0,2×Exp(0,104×2+3×0,663-3×0,519-0×0,849=0,208+1,989-1,557-0)=0,37.

The result of 0.37 is assessed as a moderate risk of adverse outcome.

Example 2. The patient M. the time from debut to establish ILG was 0.5 years, the source FC - 2, STRef- 4, RP++ (=2).

To calculate the risk of an unfavorable outcome, have a formula according to the claimed method:

0,2×Exp(0,104×0,5+2×0,663-4×0,519-2×0,849=0,052+1,326-2,076-1,698)=0,018.

The result 0,018 assessed as low risk of adverse outcome.

Thus, the claimed method is possible with bellsouthnet to calculate the risk of adverse outcome in patients with idiopathic pulmonary hypertension and promptly appoint adequate therapy.

Method of determining risk of adverse outcome in patients with idiopathic pulmonary hypertension by conducting clinical and laboratory examination of the patient, characterized in that determine the period from the onset of symptoms to diagnosis (t) in years, define the functional class at the time of diagnosis (FCRef), calculate the cardiac output at the time of diagnosis (SV), set the ratio (X) acute pharmacological tests (RPTS), which corresponds to the value: if acute pharmacological test negative (RP-), set the value 0; if acute pharmacological test positive with one vasodilator (FUC+), set the value to 1 if acute pharmacological test with two vasodilators (PCF++), set the value to 2, the risk of unfavorable outcome (N) calculated by the formula:
H=0,2×Exp(0,104×t+0,663×FCRef-0,519×SVRef-0,849×(X)OFP),
and the result with a value ≤0,35 define low risk, 0.36 to 0.55 to moderate risk, ≥0,56 - high risk of adverse outcome.



 

Same patents:

FIELD: medicine.

SUBSTANCE: group of inventions relates to medical equipment. A cuff contains a chamber for the application of pressure to the area of measurement; a screwable element for displacement of a chamber (161) for a flowing medium to the area of measurement, and a chamber-like covering element, which includes the chamber of the flowing medium and the screwable element and is configured in the form of a tape, wrapped around the area of measurement. The screwable element has a curved shape, which follows the direction, in which the screwable element is wrapped around the area of measurement, and has two curvilinear regions and a rectilinear connecting region, which connects the said curvilinear regions in the section in the points of bending, in which the radius of the screwable element curvature changes. The connecting region is located inside the curve, formed by the extension of the curvilinear regions. The central position between the first point of bending in the section and the second point of bending in the section is superposed on the central position of the chamber for the flowing medium in the direction, in which the chamber for the flowing medium is wrapped around the area of measurement. Versions of implementation of the device for pressure measurement and an additional version of the cuff are disclosed.

EFFECT: group of inventions makes it possible to reduce the measurement error due to the reduction of errors of the chamber volume change.

6 cl, 15 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to occupational medicine, and can be used for specifying the indications for the instant correction of the psychophysiological states. A cardiointervalogram is recorded before and after professional activity. A range of RR interval lengths (MxDMnbefore, MxDMnafter), a square root of a total difference of a sequence of RR intervals (RMSSDbefore, RMSSDafter) and a mode amplitude of RR interval lengths (AMobefore, AMoafter) are determined. Differentiation functions G1 and G2 are calculated. If G1 is less than G2, the individuals being tested are considered to be in need of the instant correction of their psychophysiological states. Otherwise, it is stated that the individuals being tested are not in need of the instant correction of their psychophysiological states.

EFFECT: examining the individual before and after the occupational activity, using the cardiointervalography findings and specifying the most significant criteria for the psychophysiological states assessment make the method increase the responsiveness to the process of detection if there are any individual-specific indications for the instant correction of the psychophysiological states.

2 ex

FIELD: medicine.

SUBSTANCE: assessing a risk of recurrent atrial fibrillation (AF) is ensured by determining the patient's age in years (A), the time following radio frequency ablation in months (B), postoperative inpatient recurrent atrial fibrillation (C), the degree of the aortic valve insufficiency (D), the left atrial diameter in mm (E), anti-arrhythmic therapy conducted (F) with F=l if the anti-arrhythmic therapy involves amiodarone, and F=2 if the anti-arrhythmic therapy with sotalol is conducted, the degree of the mitral valve insufficiency (J), the number of reference ablation points (I); the number of radio frequency applications (G); the radio frequency ablation type (H) with H=2 accompanying RF labyrinth, and H=3 with the radio frequency ablation of pulmonary vein basins and ganglia plexuses. The derived values are used to calculate the risk (R) of atrial fibrillation by three formulas. The highest of the three derived R values is further determined. If the highest R value has been derived by the first formula, the recurrent atrial fibrillation following the radio frequency ablation may not be predicted. The highest R value produced by the second formula enables predicting the recurrent atrial fibrillation to come during 6 months following the radio frequency ablation.The highest R value taken from the third formula shows that the recurrent atrial fibrillation is predicted to come during more than 6 months following the radio frequency ablation.

EFFECT: method enables predicting the risk of the recurrent atrial fibrillation following the radio frequency ablation in the patients, pre-selecting a set of medical products necessary for the anti-arrhythmic and anti-coagulant treatment of the patient, pre-specifying a follow-up visit schedule and additional functional diagnostic techniques and considering if the repeated radio frequency ablation is required.

2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment. An electronic sphygmomanometer comprises a cuff, an inflation and pressure release unit for the cuff pressure adjustment, two pressure sensors, two generation circuits generating a rectangular signal at a pressure-dependent frequency, a generation circuit adjustment circuit ensuring passing an output signal from one of the above generation circuits, and a control circuit for generating an input rectangular signal from the circuit adjustment circuit and for calculating blood pressure at a rectangular signal frequency. The pressure sensors are connected to the cuff and matched with the generation circuits. The adjustment circuit is configured as a common one for the above generation circuits. The control circuit switches between the generation circuits by producing a signal of switching to one of the generation circuits. The control circuit generates the first signal of switching to the first generation circuit and determines the first cuff pressure dependent on the first rectangular signal frequency. The control circuit generates the second signal of switching to the second generation circuit and determines the second cuff pressure dependent on the second rectangular signal frequency. The control circuit detects if there is a failure of the above pressure sensors as shown by the first and second cuff pressure difference.

EFFECT: invention is expected to increase the measured blood pressure reliability when using more than one sensor.

4 cl, 9 dwg

FIELD: radio engineering, communication.

SUBSTANCE: invention relates to transceiver device for processing a medium access control (MAC) protocol used by a transceiver. The transceiver comprises a first antenna system for on-body communication and a second antenna system for off-body communication, the transceiver device being designed to reserve one or more data payloads for on-body communication and to allocate the first antenna system to the transceiver in the time interval occupied by said data payloads, and/or to reserve one or more data payloads for off-body communication and to allocate the second antenna system to the transceiver in the time interval occupied by said data payloads.

EFFECT: providing an optimally matched antenna system for on-body communication and off-body communication respectively, preventing collisions between data payloads on a radio channel, thereby increasing data throughput and, at the same time, reducing power consumption of the transceiver.

15 cl, 14 dwg

FIELD: medicine.

SUBSTANCE: patient's epicardial fat thickness is measured by transthoracic echocardiography by means of a sector transducer at a frequency of 2,500 MHz on a free anterior wall of the right ventricle. Pulse Doppler imaging is performed to determine the diastolic function of the left ventricle - the E/A ratio measured as a transmitral blood flow velocity in the early diastolic filling of the left ventricle (E peak) to a transmitral blood flow velocity in a left auricular systole (A peak). If the epicardial fat thickness is from 2.7 to 4.5 mm, whereas the E/A diastolic function is less than 0.80, insulin resistance is diagnosed.

EFFECT: higher diagnostic accuracy, as well as wider number of individuals, who had the insulin resistance diagnosis.

1 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine, namely to cardiology. A microphone signal, simultaneously passing through two band filters with fixed pass bands, is registered. The pass band of the first pulse-wave filter is set at 3-6 Hz. The pass band of the second filter of Korotkov′s tones is set at 40-120 Hz. Reliable Korotkov′s tones in the determination of systolic pressure are considered to be exceeding of a threshold value of the amplitude of the first filter output signal after the local maximum of the output signal of the first filter. The reliable Korotkov′s tones in the determination of diastolic pressure are considered to be exceeding the threshold value of the amplitude of the output signal of the second filter to the local maximum of the first filter output signal. The claimed method is realised due to the device, which includes an air pressure sensor in a cuff, a microphone, the first pulse-wave filter has the pass band of 3-4 Hz, the second filter of the Korotkov′s tones has the pass band of 40-120 Hz, a unit for the determination of maximal values of output signals of the filters, a unit for the selection of the threshold values of comparison of the output signals of the filters, a unit for the comparison of the output values of the output signals of the filters with the threshold values, a unit for the comparison of the moment when the threshold value of the output signal of the second filter is exceeded, with the moment of achieving the local maximum of the first filter.

EFFECT: group of inventions makes it possible to increase the reliability of measurements due to the reduction of the impact of external noise and interference, conditioned by the patient's physiological activity.

2 cl, 2 dwg

FIELD: medicine.

SUBSTANCE: invention relates to means for the estimation of energy efficiency of a cardiovascular system. The method of automatic processing of blood pressure signals contains stages at which: a detected pressure signal P(t) for one or more heart contractions is discretised, with each heart contraction starting at an initial moment, coinciding with the moment of the diastolic pressure, and finishing at the last moment, coinciding with the moment of the following diastolic pressure, and containing a dicrotic point, the morphology of a discretised pressure signal P(t) for each heart contraction is analysed and separated, the moment and value of pressure in one or more characteristic points of the signal P(t) are determined. For each heart contraction a value of energy efficiency is determined by the determination of the impedance Zd-D(t) of a direct dynamic wave of pressure for each of one or more characteristic points, except the point of an initial diastolic pressure, and the impedance ZD of a direct pressure wave is determined by the addition with alternating signs of values of the impedances Zd-D(t) of the direct dynamic pressure wave, ordered in accordance with the direct time order, starting with the initial moment of the analysed heart contraction, to a dicrotic moment, the dynamic reflected impedance Zd_R(t) is determined for each of one or more characteristic points and the value of impedance ZR of reflected pressure waves is determined, energy efficiency is determined as a ratio between the impedance ZD of the direct pressure wave and the impedance ZR of the reflected waves RES=ZD/ZR. The method is realised by an automatic device for processing the blood pressure signal with the application of a storage medium, which contains stored software.

EFFECT: application of the invention makes it possible to increase the reliability of energy efficiency estimation.

14 cl, 6 dwg

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine. A device used in the group of inventions comprises an input interface designed to supply signals from at least two sensors for at least two individual's positions, including the blood-dependent signals, from the first signal when the individual is found in the first position; the blood-dependent signals from the first sensor when the individual is found in the second position; the blood-dependent signals, from the second sensor when the individual is found in the first position; and the blood-dependent signals, from the second sensor when the individual is found in the second position; as well as an operational circuit designed to determine and output measures by combining the supplied signals according to the pre-set calibration data.

EFFECT: group of inventions enables calculating the measures by experimental tests.

22 cl, 5 dwg, 2 tbl

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine. An electronic sphygmomanometer contains a cuff, a unit for air filling and release, a pressure detection unit and a unit of arterial pressure calculation. One or two sensors of the pressure detection unit of are located on the first main surface of an internal circuit board. Air channels of the pressure sensors protrude on the second main surface, which is an opposite side of the internal circuit board from the first main surface. An air tube of the pressure sensors is connected with air channels. A branching air tube branches from a cuff air tube and is connected with the air tube of the pressure sensors. The air tube of the pressure sensors has connecting heads of the first and second air channels respectively, connected with the first and second air channels respectively. The internal circuit board has the first and the second protecting plates, which are located at the specified distance from the second main surface and in which respectively provided are the first and the second holes, which bring the first and the second air channels respectively on the side of the second main surface. At least one protruding element of the connecting heads of the first and the second air channels respectively mesh with the internal surface of the protective plates in the holes, when external surfaces of the connecting heads are connected with the air channels.

EFFECT: application of the inventions will make it possible to increase the accuracy of arterial pressure measurement.

5 cl, 17 dwg

FIELD: medicine.

SUBSTANCE: method involves recording heart beat rate and systolic arterial blood pressure before and after two-stage exercise stress. The first stage is of 50 W within 3 min and the second one is of 75 W during 2 min. Patient rest pause is available between loading stages to recover initial heart beat rate. Prognostic estimation of cardiopulmonary complications is carried out with mathematical formula applied.

EFFECT: reduced risk of complications in performing tests.

FIELD: medicine.

SUBSTANCE: method involves measuring cardio- and hemodynamic values, calculating estimates of the values and displaying the estimates on monitor. Measuring and calculating each cardio- and hemodynamic value is carried out during basic periods of their oscillations corresponding to heart contraction cycle and respiratory cycle related to absolute time.

EFFECT: high accuracy of estimation.

4 dwg, 1 tbl

FIELD: animal science.

SUBSTANCE: the present innovation deals with dynamic loading onto cardio-vascular system in animals. Selection should be carried out by the following parameters: , ΔT3 and Δn, where ΔT1 - the time for pulse increase at running, ΔT2 - the time for pulse stabilization after running, ΔT3 - the time for pulse increase after running, Δn - the increase of pulse frequency after running. One should select animals into milking herd at the following values; ΔT3 ≤ 10 sec, Δn ≤ 10 beats/min. The method enables to present perspective evaluation of lactation capacity in animals.

EFFECT: higher efficiency of selection.

1 dwg, 1 ex, 1 tbl

FIELD: medicine.

SUBSTANCE: method involves recording rheogram from feet and legs lifted and fixed at an angle of 45є. Then, rheogram is recorded on inhaling from legs directed vertically downward. Functional blood circulation reserve index is calculated as product of results of dividing and subtracting rheographic indices recorded under conditions of lifted and lowered extremities that means under conditions of functional venous system relief and venous hypertension, respectively.

EFFECT: enhanced effectiveness in recognizing patient group suffering from severe lower extremities ischemia.

6 dwg

FIELD: medicine.

SUBSTANCE: method involves recording rheogram from feet and legs lifted and fixed at an angle of 45є. Then, rheogram is recorded on inhaling from legs directed vertically downward. Functional blood circulation reserve index is calculated as product of results of dividing and subtracting rheographic indices recorded under conditions of lifted and lowered extremities that means under conditions of functional venous system relief and venous hypertension, respectively.

EFFECT: enhanced effectiveness in recognizing patient group suffering from severe lower extremities ischemia.

6 dwg

FIELD: medicine.

SUBSTANCE: method involves applying a set of reference values like body mass, arterial blood pressure, pulse rate in rest state and general physical condition values. Exercise stress is sequentially applied for evaluating vertebral column flexibility, response quickness, dynamic leg force, speed-and-force tolerance. Each value is compared to a reference value, the differences of each item between reference and actual values are summed and the total value is interpreted in terms of complex human physical condition.

EFFECT: high reliability of the method; simplified testing process requiring no complex and expensive equipment and high skill personnel.

6 cl

FIELD: medicine.

SUBSTANCE: method involves applying a set of reference values like body mass, arterial blood pressure, pulse rate in rest state and general physical condition values. Exercise stress is sequentially applied for evaluating vertebral column flexibility, response quickness, dynamic leg force, speed-and-force tolerance. Each value is compared to a reference value, the differences of each item between reference and actual values are summed and the total value is interpreted in terms of complex human physical condition.

EFFECT: high reliability of the method; simplified testing process requiring no complex and expensive equipment and high skill personnel.

6 cl

FIELD: medicine, juvenile clinical nephrology.

SUBSTANCE: disease duration in case of obstructive pyelonephritis should be detected by two ways: either by detecting the value of NADPH-diaphorase activity, as the marker of nitroxide synthase activity in different renal department and comparing it to established norm, or by detecting clinico-laboratory values, such as: hemoglobin, leukocytes, eosinophils, urea, beta-lipoproteides, lymphocytes, neutrophils, the level of glomerular filtration, that of canalicular reabsorption, urinary specific weight, daily excretion of oxalates, arterial pressure, and estimating their deviation against average statistical values by taking into account a child's age.

EFFECT: higher efficiency of detection.

7 dwg, 1 ex, 6 tbl

FIELD: medicine, neurosurgery.

SUBSTANCE: one should measure blood pressure in afferent vessel of cerebral arteriovenous malformation (AVM). If measured pressure is above that of functionally insignificant vessel being 25% against systemic arterial pressure for AVM at blood flow of 1000 ml/min and 50% for AVM at blood flow of 500 ml/min one should conclude the vessel to be functionally valuable. The method enables to decrease complications due to increased reliability in detecting functional value of ABM-supplying vessels.

EFFECT: higher efficiency of detection.

1 ex

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

Up!