Method for determining basic functional values of cardiac myohemodynamics

FIELD: medicine.

SUBSTANCE: method involves modeling real three-dimensional patient heart image based on electrocardiogram and photoroentgenogram data and determining basic functional values of its myohemodynamics.

EFFECT: high accuracy and reliability of the method.

2 cl, 5 dwg

 

The present invention relates to medicine, particularly cardiology, and can be used in clinical and experimental studies as a non-invasive method of determining the volume of the left ventricle (LV) and a vivid, realistic representation of the functional status of the patient's heart in real time according to the electrocardiogram.

Known non-invasive method of ultrasonic echocardiography [1]based on detection of the reflected from the detected object ultrasonic waves and enabling visualization of cardiac structures in real-time. Echocardiographic method to determine the end-diastolic and end-systolic volumes of the left ventricle of the heart, however, requires participation in the diagnosis of highly qualified specialists, the use of expensive equipment and time consuming to conduct the same survey. In addition, echocardiographic method, it is impossible to obtain accurate diagnostic information in a number of anatomical features of the patient and realistic visual picture of the process of the functioning of the heart.

The closest the result achieved by the present invention is a non-invasive way to determine the key indicators mikhelogiannaki left ventricle of the heart [2], the bookmark is different in that, that record electrocardiogram and determine end-diastolic radius (CRA) and end-systolic radius (DAC) of the LV cavity, end-diastolic volume (BWW) and end-systolic volume (CSR) LV, which are calculated according to the electrocardiogram in one of the following leads: 4, 5, 6-m breast (Wilson), or 11 standard (Einthoven), chosen accordingly to the direction of the electrical axis of the heart, and at impossibility of their registration in the abstraction a (Sky), measured in the absence of bundle branch block GIS duration intervals QR, RS, QRS, ST-T, R-R and optionally by blockade of the left bundle branch is the length of the interval R1R2and when the blockade of the right bundle branch is the length of the interval S1S2and when sinus and other supraventricular rhythms of the heart in a state of physical rest is determined by the formula:

KDR=(44,5-100·tRS)·(tQR+tRS)-11·tRSwhere tQRthe time from the beginning of the Q wave to the peak of R-wave in the absence of blockade of the left bundle branch, and in the presence of blockade of the left bundle branch to the first vertex split R-wave(R1), i.e., tQR=tQRC; tRSthe time from the peak of R-wave to the end of the prong S - in the absence of bundle branch block GIS, and the blockade of the left bundle branch instead of tRSdifferent the th time intervals from the first vertex split R-wave to the end of the prong S (R1 S) and from the first vertex split R-wave to its second vertex (R 1R2), that is,

where tQRSthe time complex, QRS, s; tST-Tthe time from the end of S-wave to the end of the T wave - in the absence of bundle branch block GIS, and the blockade of the left bundle branch, instead of tST-Tsumand when the blockade of the right bundle branch instead of tST-Tsum

and further calculates at all of these types of heart rhythm BWW=(4/3)·π·RIC3and CSR=(4/3)·π·DAC3.

The disadvantages of the known methods to determine the main indicators of mikhelogiannaki the left ventricle of the heart is that there is no calculation of basic volumetric and functional parameters of the heart, the calculation of the basic volumetric and functional parameters of the left ventricle is performed without reference to the "geometry" of the heart in a specific patient, the results of processing cardiographic information presented in the beloved and no automatic detection information of the ECG parameters and indicators mikhelogiannaki.

New methods of processing and presentation of the results of ECG analysis, according to the authors of the present invention will increase the diagnostic capabilities of electrocardiography.

In the known method the op is adelene key indicators of mikhelogiannaki the left ventricle of the heart using the classical methods of recording and analysis of ECG registration and measurement information of the ECG parameters. Then, on the basis of mathematical modeling of LV as a regular geometric shape (elastic ball) is implemented quantitative determination of almost all of the major functional indicators mikhelogiannaki LV of the heart."

Thus, in the known method the internal cavity of the left ventricle is presented in the form of an elastic ball, the radius of which is determined by the original mathematical formulas. According to the authors of the present invention, it is a fundamental distinguishing feature of this method.

The figure 1 shows the block diagram of the algorithm that implements a method of determining key indicators of mikhelogiannaki LV of the heart. On the block diagram, the following notation:

1 - registration of ECG;

2 - the analysis information of the ECG;

3 - identify indicators of mikhelogiannaki LV of the heart.

As follows from the analysis of figure 1, there is a method of determining key indicators of mikhelogiannaki LV heart is noninvasive and is the ECG registration, measurement information of the ECG parameters and the calculation of the basic volumetric and functional parameters of mikhelogiannaki LV original mathematical formulas.

The proposed method definitions of key indicators mikhelogiannaki heart is also non-invasive.

ECG is a valuable diag is eticheskim tool. It is possible to estimate the source of rhythm, regularity of heart rate, the frequency of them. All this is of great importance for the diagnosis of various arrhythmias. Duration of various intervals and teeth ECG to evaluate changes in cardiac conduction. The changes in the terminal part of the QRs complex (ST interval and the T wave) allow the physician to determine the presence or absence of ischemic changes in the heart (circulatory disorders). In the known method improvement electrocardiography as a method of functional diagnostics is conducted in the direction of the research performance of mikhelogiannaki LV of the heart depending on the electrical activity of the heart. However, on the contractility of the heart electric activity in the known method can be only indirect representation. According to the authors of the present invention, it is also crucial distinguishing feature of this method.

The ECG signal is the primary carrier of diagnostic information, and submission of the registration and analysis as much as possible of this information will greatly improve the accuracy of diagnosis.

According to the authors of the present invention, it is necessary in the analysis of the information parameters of the ECG and the identification of key indicators of migem the dynamics of the left ventricle of the heart to expand the scope of representation of diagnostic information through visual representations of "geometry" and contractility of the heart patient. Using a known way on the ECG to determine the dynamics of the main indicators of mikhelogiannaki only the left ventricle of the heart, but it is impossible clearly to model a realistic image of the patient's heart to represent these changes, and it is also impossible to determine the localization of changes of the main parameters of mikhelogiannaki LV of the heart.

Analysis of the electrocardiographic information is essential when planning a course of treatment, decision making in the diagnosis, finding ways to increase the effectiveness of treatment, and therefore the presentation of the results of the analysis more convenient for the study and interpretation of the form is preferable.

The invention is directed to expand the functionality of electrocardiographic studies due to visualise the changes of the main parameters of mikhelogiannaki heart for model realistic image of the patient's heart.

This is achieved in that in the method of determining the basic functional parameters of mikhelogiannaki LV of the heart, namely, that record the electrocardiogram and determine end-diastolic radius (CRA) and end-systolic radius (DAC) of the LV cavity, end-diastolic volume (BWW) and end-systolic volume (CSR) LV, which are calculated according to electrocardio the programmes in one of the following abstraction: 4, 5, the 6th thoracic (Wilson), or 11 standard (Einthoven), chosen accordingly to the direction of the electrical axis of the heart, and at impossibility of their registration in the abstraction a (Sky), measured in the absence of bundle branch block GIS duration intervals QR, RS, QRS, ST-T, R-R and optionally by blockade of the left bundle branch is the length of the interval R1R2and when the blockade of the right bundle branch is the length of the interval S1S2and when sinus and other supraventricular rhythms of the heart in a state of physical rest is determined by the formula: RAC=(44,5-100·tRS)·(tQR+tRS)-11·tRSwhere tQRthe time from the beginning of the Q wave to the peak of R-wave in the absence of blockade of the left bundle branch, and in the presence of blockade of the left bundle branch to the first vertex split R-wave(R1), i.e., tQR=tQRC; tRSthe time from the peak of R-wave to the end of the prong S - in the absence of bundle branch block GIS, and the blockade of the left bundle branch instead of tRS- the difference of time intervals from the first vertex split R-wave to the end of the prong S (R1 S) and from the first vertex split R-wave to its second vertex (R1R2), that is,

where tQRSthe time of the QRS complex,s; tST-Tthe time from the end of memory is CA S to the end of the T wave - in the absence of bundle branch block GIS, and the blockade of the left bundle branch, instead of tST-Tsumand when the blockade of the right bundle branch instead of tST-Tsum

and further calculates at all of these types of heart rhythm BWW=(4/3)·π·RIC3and CSR=(4/3)·π·DAC3entered the action with which register front and levobunolol fluoroscopic images of the patient's heart, is determined by the images of the geometric parameters of the patient's heart, synthesize realistic three-dimensional image of the patient's heart, the values of the CRA and DAC replace real equivalent geometrical model parameters of the left ventricle of the patient's heart, the values of which are determined by the formula

RCarli=KRIC·Ri_models; RXL=KDAC·Rmodel;The CRA=RIC3/R3srmodel;

ToDAC=DAC3/R3srmodelwhere RCarli- end diastolic distance from the center of the geometrical place of points on the surface model of the left ventricle of the patient's heart to the i-th point on the surface model of the left ventricle of the patient's heart; RXL- the end-systolic distance from the center of the geometrical place of points on the surface of the model L is the patient's heart to the i-th point on the surface model of the left ventricle of the patient's heart; Rmodel- the distance from the center of the geometric place of the points on the surface model of the left ventricle of the patient's heart to the i-th point on the surface model of the left ventricle of the patient's heart; RFodeleis the radius of the sphere whose volume is equal to the volume model of the left ventricle of the patient's heart; KThe CRAToDACthe coefficients of proportionality of the volume model of the left ventricle of the patient's heart, respectively diastolic and systolic volume of the left ventricle of the patient's heart. In this model the patient's heart is presented in the form of realistic three-dimensional images, the original point which is obtained from x-ray images by combining and non-linear scaling, and is implemented by means of computer graphics.

Put actions to their connections are new properties that allow us to determine the dynamics of the main indicators of mikhelogiannaki all my heart, clearly, on the model of a realistic image of the patient's heart to represent these changes, and also to determine the localization of changes of the main parameters of mikhelogiannaki heart. According to the authors, the evaluation of key indicators of mikhelogiannaki and the contractile function of the heart, and also a visual representation of the contractile function of the heart according to the results of the analysis of the electrical activity of the heart is the principal distinguishing feature of the proposed method. izvestno, that graphical information of the person perceives better than information, for example, in tabular form, as it is presented in a certain way. Therefore, the proposed method performed "bound" to the "geometry" of the patient's heart and visualization of the condition of the heart.

The figure 2 shows the block diagram of the algorithm that implements the proposed method definitions of key indicators mikhelogiannaki heart. On the block diagram, the following notation:

1 - registration of ECG;

2 - the analysis information of the ECG;

3 - synthesis model of the patient's heart;

4 - identify indicators of mikhelogiannaki hearts;

5 - registration fluoro;

6 - analysis of information indicators fluoro.

The figure 3 illustrates the calculation of the volume of the left ventricle by the method of disks, where ai- diameter disk in the apical position of the two-chamber heart, bi- diameter disk in the apical four-chamber position of the heart, L is the length of the left ventricle of the heart.

The figure 4 shows an image of the outline of the heart on the fluoroscopic image.

Figure 5 shows a realistic image of the model of the patient's heart.

As follows from the analysis of figure 2, the proposed way of "binding" to the "geometry" of the patient's heart is with the help of fluoroscopic images, and visualization of the state of the heart - using C the importance of realistic three-dimensional images of the patient's heart.

The essence of the proposed method is as follows (see figure 2): original register electrocardiography and x-ray data. Then on the EKG are determined by the DAC, the CRA, CSR, LV EDV heart of the patient, and the data fluoro superimposed model of the heart and by combining and non-linear scaling is "fitting" the data model of the heart to the data fluoro (see figure 4). It results mohamedanism performance of the left ventricle of the patient's heart and the geometry of the patient's heart. Further, the determination of LV volume model of the heart CSRmis carried out by known methods (see figure 3), for example, by the method of disks in two dimensions (modified algorithm Simpson) [3]. The image of LV model of the heart is represented in two mutually perpendicular planes: in the apical four-chamber position of the heart and the apical position of the two-chamber heart. In both projections, the LV model of the heart is divided into 20 discs (aiand bion figure 3) of the same height; square disks are added and the sum is multiplied by the length of the LV model of the heart. The next stage of implementation of the proposed method is to compare the volumes of the left ventricle of the patient's heart CSR and LV model heart CSRm. The obtained volume LV model of the heart is its CSR and is determined by the ratio which otnosheniya between CSR of the left ventricle of the patient's heart and CSR mLV models of the heart: KDAC=CSR/CSRmby which to multiply the coordinates of the points of the model heart. The upshot is a model of the heart with the copies of the patient's heart in systole (see figure 5). To determine the model of the patient's heart in diastole is the following ratio:

ToThe CRA=BWW/CSRm.

Thus, in the proposed method, according to electrocardiography and x-ray modeling of realistic three-dimensional images of the patient's heart and determination of basic functional parameters of mikhelogiannaki.

While retaining the known advantages of the method according to initial measuring accuracy of the ECG signal and to determine the main functional parameters of mikhelogiannaki LV.

Literature:

1. Muharlyamov NM, Belenkov YU. Ultrasound diagnosis in cardiology. - M.: Medicine, 1981, 160 S.

2. Safonov M. Method of determining the basic functional parameters of mikhelogiannaki left ventricle of the heart. RF patent №2107457, IPC And 61 In 5/02, 1998.

3. Schiller N.B. Two-dimensional echocardiographic determination of left ventricular volume, systolic function and mass. Summary and discussion of the 1989 recommendations of the American society of Echocardiography. Circulation 84().

1. The method of determining the basic functional parameters of mikhelogiannaki of the left ventricle (LV) of the heart, namely, that d is astronaut electrocardiogram and determine end-diastolic radius (CRA) and end-systolic radius (DAC) of the LV cavity, end-diastolic volume (BWW) and end-systolic volume (CSR) LV, which are calculated according to the electrocardiogram in one of the following leads: 4, 5, 6-m breast by Wilson or 11 standard Einthoven, chosen accordingly to the direction of the electrical axis of the heart, and when it is impossible to register them in the lead And the Sky, measured in the absence of bundle branch block GIS duration intervals QR, RS, QRS, ST-T, R-R and optionally by blockade of the left bundle branch is the length of the interval R1R2and when the blockade of the right bundle branch is the length of the interval S1S2and when sinus and other supraventricular rhythms of the heart in a state of physical rest is determined by the formula CRA=(44,5-100·tRS)·(tQR+tRS)-11·tRSwhere iQRthe time from the beginning of the Q wave to the peak of R-wave in the absence of blockade of the left bundle branch, and in the presence of blockade of the left bundle branch to the first vertex split R-wave(R1), i.e., tQR=tQR,; tRSthe time from the peak of R-wave to the end of the prong S - in the absence of bundle branch block GIS, and the blockade of the left bundle branch instead of tRS- the difference of time intervals from the first vertex split R-wave to the end of the prong S (R1 S) and from the first vertex split R-wave to its second vertex R 1R2), that is,

tRS=tRS2-tS1S2c;

where tQRSthe time of the QRS complex, s;

tST-Tthe time from the end of S-wave to the end of the T wave - in the absence of bundle branch block GIS, and the blockade of the left bundle branch instead of tST-T- the amount of tST-T+tR1R2and when the blockade of the right bundle branch instead of tST-Tthe amount of tST-T+tS1S2with;

and further calculates at all of these types of heart rhythm BWW=(4/3)·π·RIC3and CSR=(4/3)·π·DAC3, characterized in that the front register and levobunolol fluoroscopic images of the patient's heart, is determined by the images of the geometric parameters of the patient's heart, synthesize realistic three-dimensional image of the patient's heart, the values of the CRA and DAC replace real equivalent geometrical model parameters of the left ventricle of the patient, the values of which are determined by the formula

Ri CDRLS=KThe CRA*Ri model,

Ri XRLS=KDAC*Ri model,

Toi KDR=RIC3/R3SF models,

ToDAC=DAC3/R3SF. models,

where RCarli- end diastolic distance from the center is and geometrical place of points on the surface model of the left ventricle of the patient's heart to the i-th point on the surface model of the left ventricle of the patient's heart; Rxrls- the end-systolic distance from the center of the geometrical place of points on the surface model of the left ventricle of the patient's heart to the i-th point on the surface model of the left ventricle of the patient; Ri model- the distance from the center of the geometric place of the points on the surface model of the left ventricle of the patient's heart to the i-th point on the surface model of the left ventricle of the patient; RSF modelsis the radius of the sphere whose volume is equal to the volume model of the left ventricle of the patient;The CRAToDACthe coefficients of proportionality of the volume model of the left ventricle of the patient, respectively diastolic and systolic volumes of the left ventricle of the patient's heart.

2. The method according to claim 1, characterized in that in the process of synthesizing realistic three-dimensional images of the patient's heart starting point obtained from x-ray images by imposing the model of the heart, compositing and non-linear scaling, and the model of the heart is implemented by means of computer graphics.



 

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