The method of diagnostics of electrical instability of the myocardium in patients with cardiovascular diseases
The invention relates to medicine, namely to cardiology. The method of diagnostics of electrical instability of the myocardium in patients with cardiovascular disease includes the study of blood, thus define the integral leukocyte indexes: leukocyte index (LI), leukocyte index of intoxication (LII), the index shift of leukocytes (LIS), an index of the ratio of neutrophils and lymphocytes (INL), and with increasing LI>0,85, and reducing LII<0,5, LIS<1,3, ICNL<1,41 diagnose electrical instability of the myocardium, and recognition rather change the values of two or more indexes. Technical result: a simple way, allows you to assess the risk of malignant ventricular cardiac arrhythmias and may be recommended for identification of risk groups, improving forecast accuracy and reduce the complexity. table 1.
The invention relates to medicine, namely to cardiology. It is known that about 60-70% of deaths from cardiovascular disease begins abruptly. The proportion of cases of sudden cardiac death (SCD) of the total number of deaths at the age of 1 year to 13 years is 19%, and aged 20-64 years is about 60% which is arrhythmic syndrome, which when it is malignant for should the fatal episode as ventricular fibrillation. In the light of modern concepts of organic lesions of the heart and blood vessels themselves are often insufficient for the occurrence of fatal arrhythmias. In this regard, progress to further study the problem of “Sudden cardiac death” is largely associated with finding a variety of trigger factors and cardiac extraordinally nature. Therefore, the problem of creating an accessible and fairly reliable way to detect electrical instability of the myocardium remains quite relevant.
As an analogue of the proposed method for the diagnosis of electrical instability of the myocardium based on a comprehensive evaluation of clinical examination and functional test: Holter monitoring ECG, echocardiography, load test data signal-averaged ECG, assessment of heart rate variability (Pozdnyakova N. In. Electrical instability of the heart: prognostic significance. Abstract of Diss. Dr. M. N., Samara 2001-323 C.). The author of this method, the algorithm of the survey and the list of factors the risk - stratification of predictors of adverse PR implement this method, it is necessary to conduct special studies, where busy professionals functional diagnostics, and used modern expensive equipment.
As the prototype is proposed a method of forecasting the electrical instability of the myocardium based on the high content of free fatty acids in blood plasma as a predictor of SCD in patients with coronary artery disease (Kalinkin M. The pathogenesis of atherogenic lipid metabolism disorders before the onset of sudden coronary death. Abstract of Diss. D. M. N. St. Petersburg, 1994, 237 C.). The main methods used to determine the lipid content in the blood plasma, were the following: 1) obtaining a lipid extract of the investigated samples (Folch J. et. al., 1957); 2) thin layer chromatography of total lipids and phospholipids (Kargapolov A. C., 1981); 3) spektrofotometricheskoe determining the amount of lipid fractions (Marsh J. B., Weinstein D. C. 1966);
Despite the obvious importance of the method, its implementation requires the use of special laboratory techniques are not available to all medical institutions, moreover, are not developed specific criteria for increasing the level of this indicator, determining the electrical instability of the myocardium.
It is known that various disrete in turn lead to the involvement in the processes of adaptation of the immune system and its most important part - nonspecific resistance of the organism. In patients with ventricular extrasystoles high gradation on the background of the cardiac pathology of various origins shifts in leukocyte formula of the blood on the nature of these changes it is possible to predict the electrical instability of the myocardium.
The authors propose a method for the diagnosis of electrical instability of the myocardium on the basis of indicators integral leukocyte indexes: leukocyte index (LI), leukocyte index of intoxication (LII), index shift of leukocytes (LIS) and the index of the ratio of neutrophils and lymphocytes (INL) calculated on the basis of data leukocyte blood.
The methodology of the study: the study of the morphological composition of the blood is performed using microscopy of smears stained by Romanovsky-Giemsa. The leukocyte count is conducted on Garkavi L. H. and et al. (1990).
On the basis of the leukocyte formula is calculated leukocyte index (LI) as the ratio of lymphocytes to segmented neutronium
Diagnostic value is increased IF more than 0.85.
Leukocyte index of intoxication (LII) is calculated as the ratio of production, the denominator is the sum of lymphocytes and monocytes, multiplied by the amount of eosinophils and units
Diagnostic value has reduced LII less than 0.5.
The shift index of leukocytes (LIS) is determined by the ratio of granulocytes (sum of eosinophils, basophils, segmented and band neutrophils) to agranulocytes (sum of lymphocytes and monocytes).
Diagnostic value has decrease LIS less than 1.3.
The index is the ratio of neutrophils and lymphocytes is calculated by the formula
Diagnostic value has reduced INL less 1,41.
When the specified value changes two or more indexes diagnose electrical instability of the myocardium.
Surveyed 116 patients with cardiac pathology of various origins. Of these, 75 patients with ischemic heart disease with stable angina FC I-IV. Also examined a group of patients with coronarienne pathology 41 people. Range nosology included: mitral valve prolapse, abnormal chordae left heart syndrome Wolff-Parkinson-white, idiopathic arrhythmia. All patients were without congestive heart failure and severe comorbidities. All the leukocyte blood, on the basis of which was calculated proposed indexes - LI, LII, LIS, ISNL. For the purpose of diagnosis of cardiac arrhythmias was conducted Holter ECG monitoring on the basis of the results in both groups were allocated to 2 groups: 1-I am with benign arrhythmia (supraventricular and rare single ventricular premature beats): 2-I - ventricular extrasystoles II-V of gradations in Lown Wolf. Values leukocyte indexes in the studied groups are presented in the table.
Based on the data available values of the investigated indices corresponding to the electrical instability of the myocardium: LI>0,85, LII<0,5; LIS<1,3; INL<1,41.
IF 1,53>0,85; LII 0,13<0,5; LIS 0,79<1,3; INL of 0.75<1,41.
2) were changed respectively diagnostic values of electrical instability of the myocardium. The obtained result corresponds to the data indicating the presence of high risk is CNA ventricular extrasystole more than 30 per hour (arrythmia II gradations in Lown-Woli). At VEM background load 50 W have any paroxysm unstable ventricular tachycardia, superovulate yourself. In the future the patient died suddenly without signs of progression of angina.
Example 2. Patient S. 53 years. Was observed as outpatients with a diagnosis of ischemic heart disease: angina III FCL PIX (1998) N. I. complained of recurrent pain stenocardias character corresponding angina FC III, frequent interruptions in heart work.
DO=0,43<0,85; LII=0,64>0,5; LIS=1,78>1,3; INL=2.73>1,41.
Thus, in this patient none of the four indices did not reach the values corresponding to the electrical instability of the myocardium. The obtained result corresponds to the data indicating the absence in the patient of dangerous arrhythmias.
On further investigation, they were not identified on the Holter ECG monitoring and the execution of load tests.
Thus, compared with the prototype of the claimed method has the following advantages:
1. Change leukocyte index (LI), leukocyte index of intoxication (LII), index shift of leukocytes (LIS), the index of the ratio of neutrophils and limfotsitov the>2. For the implementation of the method there is no need to use complicated equipment is required to conduct a unified morphological examination of blood, which is a required component of the survey, thus the method is simple and can be done in a few minutes in the clinical laboratory at any level.
3. The recommended way to identify at-risk groups, improving forecast accuracy and reduce the complexity.
The method of diagnostics of electrical instability of the myocardium in patients with cardiovascular disease, including the study of blood, wherein the determined integral leukocyte indexes: leukocyte index (LI), leukocyte index of intoxication (LII), the index shift of leukocytes (LIS), an index of the ratio of neutrophils and lymphocytes (INL), and with increasing LI>0,85, and reducing LII<0,5, LIS<1,3, ICNL<1,41 diagnose electrical instability of the myocardium, and recognition rather change the values of two or more indexes.
FIELD: medicine, psychiatry.
SUBSTANCE: one should isolate DNA out of lymphocytes of peripheral venous blood, then due to the method of polymerase chain reaction of DNA synthesis one should amplify the fragments of hSERT locus of serotonin carrier gene and at detecting genotype 12/10 one should predict the risk for the development of hallucino-delirious forms of psychoses of cerebro-atherosclerotic genesis.
EFFECT: more objective prediction of disease development.