The method is non-invasive diagnostics of local functional activity and local (sectoral) contractility of the left ventricle in patients with chd

 

(57) Abstract:

The invention relates to medicine, cardiology. Provide registration of the ECG and its first derivative. Calculate the arithmetic mean of the magnitude of the local velocity activation of the left ventricle relative to the maximum amplitude of the differential curve of the QRS complex to the maximum amplitude of the QRS complex normal ECG for 5 standard segments of the left ventricle. For peredneaziatskogo segment use leads V3, V4, V7, V8, V9. For anterolateral - V3, V4, V5, V6, 1, aVL. For apical segment, V3, V4, V5. For diaphragmatic segment 11, 111, aVF. For nizhnevokzalnaja segment - V7, V8, V9. The method allows to indirectly assess the level of sectoral coronary blood flow in the left ventricle. table 1.

The method is non-invasive diagnostics of local functional activity and local (sectoral) contractility of the left ventricle in patients with coronary artery disease.

The invention relates to medicine, particularly cardiology.

Dysfunction of the myocardium in patients with ischemic heart disease are not always due to his necrosis or cicatricial lesions [Belenkov Y. N., Saidov, M. A., 1999]. One of the characteristic features Insisiting ischemia in the pool of affected coronary arteries [Komarov F. I., Albanska L. I., 1978].

Source ischemic disorders of left ventricular contractility is often contradictory and in most cases is multifactorial. Moreover, in the mosaic myocardial damage areas are no signs of mechanical activity, but retained the basic physiological functions. As a consequence, the distinction between viable and nonviable tissue in patients with the expressed dysfunction of the left ventricle is of great clinical importance and should be evaluated in each specific case. Only in the detection of myocardial viability become justified measures of revascularization, and on the contrary, in the absence of data about the viability of conservative therapy or transplantation of the heart.

Known methods, allowing to estimate the local myocardial contractility, it is primarily the radiopaque ventriculography, positron emission tomography, single photon emission tomography and stress echocardiography [Belenkov Y. N., Saidov, M. A., 1999] currently are costly in operation, not readily available for most clinics in the country, and most importantly they are not costanda of the left ventricle.

The closest in technical essence and the achieved effect is a method of non-invasive diagnostics global disruption of adaptation and electrophysiological processes in the heart using ECG and its first derivative [Volkov, E. G., 1972, 1978], which reflects the speed parameters of the electrical activity of the heart - rate activation of the ventricles.

A broad introduction to the practical cardiology method global estimates of the rate of activation of the ventricles of the heart allows early non-invasive diagnosis of the functional state of the myocardium and its adaptive properties in the target population adult population.

The objective of the invention is to ensure the implementation of non-invasive diagnostics of local functional activity of the myocardium and local contractility of the left ventricle in patients with ischemic heart disease in combination with arterial hypertension and without it.

The technical result of the invention is the introduction and wide use of the proposed method in practical cardiology.

The specified task in the known method of non-invasive diagnostics of local function is s CHD is implemented by recording ECG and its first derivative, characterized in that the integral estimation of the average arithmetic is carried out in five blocks of standard ECG leads.

Studies on patents and scientific and technical information sources showed that the proposed method is unknown and should not be explicitly studied the prior art, i.e., meets the criteria of "novelty" and "inventive step".

The proposed method can be used in any hospital, equipped with standard facilities.

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

The proposed method is as follows: the electrical activity of the heart and its first derivative is studied using ECG recording and its first derivative at any electrocardiograph with an electronic console, with the time constant 0,0075 producing an analog-to-digital conversion of the ECG, which permitted a high degree of differentiation of the original signal.

Calculation of the rate of activation of the ventricles of the heart was performed by the method of E. G. Volkova (1976), as the ratio of the maximum amplitude of the differential curve of the QRS complex to the maximum amplitude tx2">

For the study of local electrical activity in 5 standard segments of the left ventricle, ECG and first derivative are recorded in the following blocks leads:

Perednezadny segment - V3, V4, V7, V8, V9.

Anterolateral segment - V3, V4, V5, V6, I, aVL.

Apical segment, V3, V4, V5.

Diaphragmatic segment II, III, aVF.

Negabinary segment - V7, V8, V9.

For each segment, calculate the magnitude of the local velocity activation of the left ventricle is carried out in each of the above standard lead, and then the arithmetic mean of the individual, which reflects both local functional activity of the myocardium, and indirectly the local myocardial contractility in this segment.

The presented invention is based on the identification of close direct correlations of the local speed of activation of the ventricles and local contractility.

So local myocardial contractility of the left ventricle studied by applying the contours of the left ventricle in systole and diastole using different methods of combining silhouettes when conducting Renggli an angle of 30. This allowed us to set boundaries and extent of areas of akinesia and dyskinesia [Savchenko A. P., E. Pomerantsev Century, Pavlov N. A. and others, 1988]. For an objective assessment and a correct interpretation of the severity of the condition violations of local contractility of the left ventricle contour of the left ventricle was divided into 5 segments. Allocated perednezadny, anterolateral, apical, diaphragmatic and nizhnemantiinye segments, which correspond (in percent) as follows: 16:29:19:19:17.

The degree of reduction of each segment is identified by referring to the difference between end-diastolic and end-systolic areas of the segments to the end-diastolic area in percent. The percentage reduction of area segments were total regional contractility. Depending on the Protocol were developed normal indicators of local contractility of the myocardium for each of the 5 segments. The deviation of the metric from the norm on 1 or 2 medium-square deviation is regarded as an indicator of hypokinesis of the corresponding segment.

Study of the possible correlation between the local speed of activation of the left VC is her class IIB and stable angina II, III functional class in combination with arterial hypertension and without it revealed a significant (p<0,01) direct correlation relationship (table).

The analysis of the conducted research allows to draw the following conclusions:

- The value of the local speed of activation of the left ventricle reliably quantify not only learn the local level of functional activity of the myocardium, but also indirectly the state of the local contractility of the left ventricle, and also allows dynamic monitoring of their changes.

The comparison of the level of local functional activity of the studied segments of the myocardium of the left ventricle with the presence or absence of signs of local mechanical activity allows to differentiate viable myocardium from non-viable.

- Special value represents the proposed method for the diagnosis and monitoring of potentially reversible dysfunction infarction - myocardial hibernation, "myocardial of clouded", stunning associated with acute, recurrent violation of coronary blood flow, which disappears when reperfusion or after successful riascos the circulation in the left ventricle, to trace the relationship between ischemic damage and recovery time local contractility of the left ventricle, and to explore the dynamics is numerous factors that determine and affect the restoration of the function of the investigated sectors after coronary revascularization.

The method is non-invasive diagnostics of local functional activity and local (sectoral) contractility of the left ventricle in patients with coronary artery disease by ECG registration and its first derivative, characterized in that calculates the arithmetic mean of the magnitude of the local velocity activation of the left ventricle relative to the maximum amplitude of the differential curve of the QRS complex to the maximum amplitude of the QRS complex normal ECG for 5 standard segments of the left ventricle, and for peredneaziatskogo segment use leads V3, V4, V7, V8, V9, anterolateral - V3, V4, V5, V6, 1, aVL, apical segment - V3, V4, V5, for the diaphragmatic segment 11, 111, aVF, for nizhnevokzalnaja segment - V7, V8, V9.

 

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SUBSTANCE: method involves carrying out ultrasonic scanning examination of subclavian artery over its whole extent in physiological arm position with arterial blood pressure being measured in the middle one third of the arm. Next, when applying compression tests, blood circulation parameters variations are recorded in distal segment of the subclavian artery with arterial blood pressure being concurrently measured. Three degrees of superior thorax aperture syndrome severity are diagnosed depending on reduction of linear blood circulation velocity and arterial blood pressure compared to their initial values. Mild one takes place when linear blood circulation velocity reduction reaches 40% and arterial blood pressure 20% of initial level, moderate one when linear blood circulation velocity reduction reaches 70% and arterial blood pressure 50% and heavy one when linear blood circulation velocity reduction is greater than 70% of initial level and arterial blood pressure is greater than 50% to the extent of no blood circulation manifestation being observed in the subclavian artery.

EFFECT: high accuracy of diagnosis.

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