Method for the diagnosis of postinfarction left ventricular aneurysm

 

The invention relates to medicine, cardiology. Patients record the ECG in the 80 points on the surface of the chest. Build isointegral and isointegral differential map QRS intervals. Analyze indicators: QRST morphology, the shape of the QRs complex, the ratio of negative extremum positive, the value of the integral on the cards. The obtained parameters are substituted in the discriminant equation for aneurysm and scarring. Conclusion patients with postinfarction aneurysms do when comparing the values of these equations. The method allows non-invasive detection of the presence postinfarction aneurysm and to optimize treatment. 2 Il.

The invention relates to medicine, namely to cardiology and cardiosurgery.

Coronary heart disease (CHD) is one of the most important and challenging problems in modern cardiology. Despite the complex of measures aimed at prevention and suspension of atherosclerotic lesions of the coronary arteries, coronary heart disease has a progressive course, which often becomes acute myocardial infarction. One of its complications is an aneurysm of the left ventricle, which havim ST-segment elevation. On autopsy data, the incidence of post-infarction aneurysm is 8.5-34%. There are many non-invasive methods for diagnosing coronary artery disease and post-infarction aneurysm of the left ventricle, such as graphical methods for evaluating the electrical and mechanical activity of the myocardium, myocardial perfusion, methods of direct visualization of the heart and coronary arteries (Belenkov Y. N. Non-invasive methods for diagnosis of ischemic heart disease//Cardiology. -1996. -N1. -S. 4-11).

A known method of surface ECG mapping (PC) designed for full analysis of the electric field of the heart (Mirvis D. M. et al. Body surface mapping. Boston, 1988). The measurement results when the PC is the set of maps of the distributions of the various parameters of the electric field of the heart on a surface scan of the chest. Known isointegral card, when building in which each lead is calculated the area under the curve of the ECG for a specified interval of the cardiac cycle. Known differential map, the construction of which calculates a difference between two values of the potentials (differential isopotential) or two values of the square in one and the same point on the surface of the thorax (differential, integral) with two poslezavtrashny to assess and localize areas of myocardial ischemia in coronary artery disease, as well as for prediction of myocardial infarction (Mirvis D. M. et al. Body surface mapping. Boston, 1988). Also known publication (golukhov E. H. , Polyakov, I. P., Adamian, M., kulyamin A. I. Diagnosis of Cicatricial changes of the myocardium in patients with ischemic heart disease on the background of the siege left bundle branch//Cardiology. 1988 at M.V.Lomonosov. -N11. -S. 43-49), which analyzed data from a PC, obtained during examination of patients after myocardial infarction, which also had a blockade of the left bundle branch. According to the discriminant analysis, the diagnostic reliability of these parameters for the diagnosis of postinfarction aneurysm of the left ventricle (LV) was quite high (75 to 85%).

However, none of the above works was the issue of non-invasive diagnosis of postinfarction aneurysm of the left ventricle.

The task of the present invention is to improve the accuracy of non-invasive diagnosis of postinfarction aneurysm of the left ventricle.

The task is solved by data analysis, integral and differential integrated cards QRS. To evaluate the integral cards QRS used the Min/Max ratio of negative extremum (mV*MS) to the positive extremum (mV*MS). To assess differential ka is and the appropriate lead on the surface map of the studied patient; Nmean value and standard deviation of the integral in the corresponding abstraction in the group norm; is computed at each point; 2) %DI < -2 - that part of the area scan, which takes negative values of the index difference < -2 (in % of the whole map).

Visually doctor determines the morphology of QRST-complexes split them into two categories depending on the similarity with the "typical aneurysmal complex": "similar" and "dissimilar".

To improve the accuracy of differential diagnosis of the aneurysm and cicatricial lesions of the myocardium method was used stepwise discriminant analysis. This method makes it possible to "split" the groups investigated by constructing a discriminant equations, which include the monitoring indicators. When using this method, the following indicators have the greatest diagnostic significance: 1) the morphology of the QRST complex, 2) Min/Max ratio and 3) %D < -2 (QRS map).

Built discriminant equation based on the data obtained are the following: aneurysm: -8,24133 + 5,06797*M - 2,17702*Min/Max + 0,24045*(%DI < -2) for cicatricial changes: -2,46694 + 0,62891*M - 1,07529*Min/Max + 0,15851*(%DI < -2),
where M is the morphology of the QRST complex: 1 - tipichnata to the same group, for which the calculated value is the greatest. The sensitivity and specificity of the differential diagnosis of aneurysm and scar using discriminant equations respectively 84% and 89%, diagnostic reliability of 87% (these values are obtained on the same sample of patients).

In Fig.1A presents a differential map QRS patients with aneurysms peredneperegorodochnoj and apical localization. Min DI=-4,6, Mean DI=-2,9, %DI <-2=10%, Min/Max=-1,8.

Arrow indicates lead ECG shown in Fig.1B with a minimum value of index-difference form of the ventricular complex of the type "aneurysmal".

In Fig.2A presents a differential QRS patient with robovie changes in the myocardium peredneperegorodochnoj and apical localization. Min DI=-4,4, Mean DI=-2,7, %DI < -2=13%, Min/Max=-1,6.

Arrow indicates lead ECG shown in Fig.2B indicates the minimum value of the index difference form of the ventricular complex of the type of "scar".

Clinical applications of the proposed diagnostic method allows to solve the important issue of non-invasive diagnosis of postinfarction changes in the myocardium of the left ventricle, as timely a correct diagnosis depends on the forecast dallasclinical examples of application of the method of surface mapping for the differential diagnosis of cicatricial lesions and aneurysms of the left ventricle data analysis, integral and differential maps.

Example 1 (the patient).

In the analysis of integral maps for negative extremum (mV*MS) to the positive extremum (mV*MS) - Min/Max - is - 3,432. In the analysis of differential maps QRS %DI < -2 is equal to 17 (% of the whole map). Visual assessment of the morphology of the QRST complexes characterizes them as "typical aneurysmal complexes (M=1).

Substitute these values in the discriminant equation
for aneurysms:
-8,24133 + 5,06797*1 - 2,17702*(-3,432) + 0,24045*17 = 8,3357
for cicatricial changes:
-2,46694 + 0,62891*1 - 1,07529*(-3,432) + 0,15851*17 = 4,5470
According to the results of discriminant analysis equations the patient belongs to the group of patients with LV aneurysm, because the values in the equation for aneurysm greatest.

Example 2 (patient X).

In the analysis of integral maps for negative extremum (mV*MS) to the positive extremum (mV*MS) - Min/Max - is - 0,8273. In the analysis of differential maps QRS %DI < -2 is equal to 10 (% of the whole map). Visual assessment of the morphology of the QRST complexes characterizes them as "atypical aneurysmal complexes (M=0).

Substitute these values in the discriminant equation
for aneurysms:
-8,24133 + 5,06797*0 - 2,17702*(-0,8273) + 0,24045*10 = -4,0356
for cicatricial changes:
-2,46694 + 0,62891*1 - 1,07529*(-0,8273) + 0,15851*10 = 0,0078
According to the results of analizicisi and the equation for scarring of the greatest.


Claims

Method for the diagnosis of postinfarction left ventricular aneurysm, including registration of ECG and analysis of the QRS interval, characterized in that the surface of the thorax of the patient to impose 80 ECG electrodes record the ECG in these moistened points, log data is subjected to computer analysis, build isointegral and isointegral differential map QRS intervals, calculate indicators: the morphology of the QRST complex form of the ventricular complex is estimated visually by a doctor as 1 when a typical aneurysm form, 0 - unusual for aneurysm shape, the ratio Min/Max is the ratio of the negative extremum (ÁvMS) to the positive extremum (ÁvMS) integrated maps, %DI<-2, where %DI - of the area of the scan, which takes a negative index value of the difference calculated by the formula (P-N)/where P is the value of the integral in the corresponding abstraction on surface map of the studied patients, N andmean value and standard deviation of the integral in the corresponding abstraction in the group norms on differential maps QRS, hr/8226.gif">M -2,17702Min/Max + 0,24045(%DI<-2), and robovie changes: -2,46694 + 0,62891M -1,07529Min/Max + 0,15851, where M is the morphology of the QRST complex: 1 - typical aneurysm, 0 - atypical for aneurysm, and make a conclusion about the patient's post-infarction left ventricular aneurysm in excess of the value equation for aneurysm over the value equation for scarring.

 

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