Method for predicting syndrome of incomplete diastole in patients with idiopathic hypertrophic cardiomyopathy

FIELD: medicine, cardiology.

SUBSTANCE: the present innovation deals with ways for ultrasound diagnostics of cardiac contractile function. It includes Doppler tissue myocardial studying followed by detecting regional value of deformation and myocardial deformation rate into diastole at curved M-mode Strain Rate, performing quantitative analysis at Strain mode, moreover one should calculate myocardial deformation value into diastole at ECG at the level of P tooth and at its value being above 5% it is possible to diagnose the syndrome of incomplete diastole.

EFFECT: higher accuracy and efficiency of diagnostics.

6 dwg, 1 ex, 1 tbl

 

The invention relates to medicine, namely cardiology, in particular to methods of ultrasound diagnosis of myocardial contractility.

The known method standard echocardiography (EchoCG) studies of the heart, where the assessment of diastolic function of the left ventricle is on transmitral blood flow, rarely, blood in the pulmonary veins. Standard Echocardiography assesses global diastolic function is impaired filling and relaxation of the left ventricle and/or right ventricle of the heart. The disadvantage of this method is that the identified indicators transmitral blood flow depend on the availability of valvular pathology, regurgitation, preload [1]. In addition, with the known method it is impossible to estimate the longitudinal diastolic function of the left and/or right ventricles of the heart, thereby reducing its information content.

Closest to the claimed is a method for diagnosing a longitudinal diastolic function of the left ventricle and/or right ventricle of the heart tissue Doppler study in pulse mode, Pulse Wave Doppler Tissue Imajing and/or in the Tissue Velocity Imagine [2]. Tissue Doppler study in comparison with standard Echocardiography allows the study of any structure of the heart over time and also allows you to make selections segmental the regional areas of infarction and to conduct a quantitative analysis of the profiles nutritionalvalue speed on the thickness of the walls. The essence tissue Doppler study is to estimate the velocities of the peaks "s", "e", "a", as well as assessing the relationship peaks "e/a" and timings isovolumic relaxation ("ivrt) and isometric contractions ("ivc"). When the value of the indicator "e" is less than 1.0 and the lengthening of time isovolumic relaxation 90 MS and defines a longitudinal diastolic dysfunction of the left and/or right ventricles of the heart [3, 4].

The disadvantage of this method is that the translational motion of the heart and rotation of the heart affect the change in thickness of the heart muscle in any segment. Thus, the difficulty of measurement of segment in the systole and diastole makes it impossible for the diagnosis of syndrome of incomplete diastole and therefore impossible selection of appropriate therapeutic measures.

A new technical challenge - improving the accuracy and informativeness of early diagnosis of the syndrome of incomplete diastole.

The task to solve a new method for the diagnosis of syndrome of incomplete diastole in patients with idiopathic hypertrophic cardiomyopathy by tissue Doppler studies of the myocardium and definitions of regional indicator strain and strain rate of the myocardium in diastole, and the study was conducted in a curved M-mode Strain Rate and perform the number is the result of the analysis in the mode of Strain, on ECG before, and P wave count value of deformation and rate of deformation more than 5 percent diagnose the syndrome of incomplete diastole.

The method is as follows. At room temperature 20-22°With the patient lying on the left side of perform tissue Doppler study of the apical positions at level 4 and 2 chambers of the heart and along the long axis of the left ventricle. The registered curves assess diastolic velocity peak "e", "a", the ratio of peak e/a", time isovolumic relaxation of the left ventricle or the right ventricle and systolic peak "s". Tissue Doppler spectrum recorded from the annulus of the mitral valve on the side of each of the 6 walls of the left ventricle (septal, lateral, rear, bottom and front walls, and then from segments (basal, middle and apical on each side of the left ventricle. Each wall of the left ventricle is divided into three equal parts (segments) [2]). Then tissue Doppler spectrum recorded from the annulus side wall of the right ventricle and from each of the three segments of the wall of the right ventricle (lateral wall of the right ventricle is divided conditionally on three equal parts). Indicators of tissue Doppler spectrum from the fibrous ring mitral the aqueous or tricuspid valves indicate global longitudinal systolic or diastolic function of the left or of the right ventricle [2, 5, 6], and from the segments about the longitudinal segmental systolic or diastolic function of the left or right ventricles [7, 8]. However, the applied method for quantitative assessment of longitudinal function of the left and/or right ventricles cannot diagnose the syndrome of incomplete diastole.

Then, in the mode of-line is parsed curved M-mode Strain Rate. This qualitative analysis, the staining of the spectrum in the systole and diastole can be a sign of Chinese walls. OK in the systole is orange-red staining, indicating that the high speeds of this section of the myocardium in diastole is dominated by low speed, they are colored in cyan and blue color and lack of speed - staining in green. In the proposed project, brightly colored stripes in diastole any segment from any of the 6 walls of the left ventricle shows that in diastole are high speed, therefore, it is the syndrome of incomplete diastole, which can be diagnosed in the high-quality version.

Then performed a quantitative analysis in the mode of Strain. Before, and P wave of the ECG (when the norm is no deformation of the myocardium or she approaches zero) calculate the value of deformation. Its value more than 5% indicates the syndrome remains inconclusive diastole.

Clinical example.

Azienda M Diagnosis: Idiopathic hypertrophic cardiomyopathy (IGMP). Standard Echocardiography revealed asymmetric form of hypertrophy of the left ventricle, which was manifested in the thickening of the interventricular septum (annuals) - 23 mm, the thickness of the posterior wall of the left ventricle (ssli) - 16,6 mm (figure 1). Has been a violation of global diastolic function of the left ventricle (values: impaired filling of the left ventricle (E/Amitr=0,67) and impaired relaxation of the left ventricle (IVRT=115 MS). Conducting tissue Doppler image of the myocardium in the modes of pulsed tissue Doppler studies and TVI found a violation of longitudinal left ventricular function (value "e" from the annulus of the mitral valve and the segments of the left ventricle is less than 1.0 time sovmetnogo relaxation 100 MS). Thus, the investigations have not been diagnosed with the syndrome of incomplete diastole. Execution curved M-mode Strain revealed a high Rate of speed values of the strain rate in the following segments of the left ventricle during diastole: the apical and mid segments of the interventricular septum and basal segment of the lateral wall of the left ventricle. Figure 2 high strain rate are recorded in the apical and mid segments of the interventricular septum (red-orange the first color during diastole indicated by arrows). While the period of diastole should be painted in blue and green. Figure 3 is indicated by arrow a high speed during diastole basal segment of the lateral wall of the left ventricle. As an example of the lack of syndrome unfinished diastole in a patient IGMP is given in Fig 4 (curved M-mode Strain Rate of the lateral wall of the left ventricle). Figure 5 is curved M-mode Strain Rate in healthy volunteers. During systole at high speeds observed staining in the orange-red color. At low speeds during the phase of rapid filling - in blue color, in the absence of speed - staining in green color.

It is possible to diagnose the syndrome of incomplete diastole in the high-quality version. In quantitative variant syndrome of incomplete diastole was diagnosed with Strain. The rate of deformation level, and P wave was minus 7% (6). Figure 6 B shows the absence of the syndrome of incomplete diastole in a patient IGMP (percent strain level, and P wave amounted to minus 1.5%).

Thus, according to the standard examination of the patient syndrome unfinished diastole was not diagnosed, and according to the proposed method was revealed this syndrome, which was confirmed later when monitoring a patient.

The proposed criteria are selected on on the basis of the data analysis of clinical observations for this category of patients. The study included 17 patients with idiopathic hypertrophic cardiomyopathy, non-obstructive form. The control group consisted of 25 healthy volunteers.

The use of curved M-mode Strain Rate and Strain allows to detect high velocity in diastole, thereby obtaining information about the presence of deformation in this segment, while the diastole is inherent only in low speed and no distortion. It was detected in 17 patients with idiopathic hypertrophic cardiomyopathy. This phenomenon was not inherent to all segments significantly more likely he averaged hypertrophic segment and in the basal, middle segments of the lateral and posterior walls of the left ventricle. Probably, this phenomenon develops in these patients due to violations of synchronism of contraction and relaxation of the left ventricle. It should be noted that against the background of therapy with a calcium antagonist of the isoptin SR at a dose of 120 mg/day, this phenomenon disappeared two of the three patients. Using standard echocardiography and pulsed tissue Doppler studies and/or Tissue Velocity Imaging was not possible to detect this phenomenon and to evaluate the effect of treatment on the presence of the syndrome of incomplete diastole. The lack of deformation in diastole or deformation less than 5% at Strain and low speeds or absence is of Karosta in diastole (curved M-mode Strain Rate) was observed in healthy volunteers, that illustrates the table.

Thus, the proposed method allows to diagnose the syndrome of incomplete diastole in patients with idiopathic hypertrophic cardiomyopathy, which enables us to assign adequate pharmacotherapy and to prevent the risk of sudden death in these patients. Also, this phenomenon can be used to assess the effectiveness of therapy.

The values of the deformation segment (Strain) in patients with idiopathic hypertrophic cardiomyopathy and in healthy volunteers
DetectionPatients with idiopathic hypertrophic cardiomyopathy (n=17)Healthy volunteers (n=25)
The syndrome of incomplete diastoleThe syndrome of incomplete diastole no
Strain - estimation of deformation19,78±3,12%3,56±1,20%*1,21±0,24*
P<0,01
Curved M-mode Strain RateIn diastole is marked speed, painted in red-orange colorIn diastole is marked speed, painted in blue, blue is th and green color In diastole is marked speed, painted in blue and green color
Note.# p<0.05, the significance of differences between healthy volunteers and patients IGCN without the syndrome of incomplete diastole

LITERATURE

1. Clinical manual ultrasonic diagnosis / edited Thu, Vasantha. V volume. - M.: Vidar, 1998. - s.

2. Nikitin NP, Cleland SHOSTAKOVICH Application of myocardial tissue Doppler echocardiography cardiology /Cardiology 2002; 3: 66-79.

3. Garcia-Femandez M.A., Azevedo J., Moreno, M., Bermejo, J., Perez-Castellano n, P. Puerta, M. Desco, C. Antoranz, J.A. Serrano, E. Garcia, Delcan J.L. Regional diastolic function in ischemic heart disease using pulse wave Doppler tissue imaging. // Eur. Heart J. 1999; 20: 496-505.

4. Garsia-Femandez M.A., Zamorano J., Azevedo J. Doppler Tissue Imaging. Echocardiography. Madrid, 1998 - p.36-44; p.91-100.

5. Gulati V.K., Katz W.E., Follansbee W.P. Gorscan J. 3rd. Mitral annular descent velocity by tissue Doppler echocardiography as an index of global left ventricular function // Am. J. Cardiol. 1996; 77 (11): 979-84.

6. Wandt b :ong-Axis Contraction of the Ventricles: A Modem Approach, but Already Described by Leonardo da Vinci // J. Am. Soc. Echocardiogr. 2000; 13 (7): 699-706.

7. Zamorano J. Is tissue Doppler echocardiography : ready for clinical application? // Eur. Heart J. 1998; 20 (8): 558-60.

8. Silva C.E.S., Ferreira L.D.C., Peixoto L.B., Monaco C.G., Ortiz J. Study of the Myocardial Contraction and Relaxation Velocities through Tissue Doppler Imaging Echocardiography. A New Alternative in the Assessment of the Segmental Ventricular Function // Arq. Bras.Cardiol. 2002; 78 (2): 206-11.

A method for the diagnosis of syndrome of incomplete diastole in patients idiopathically hypertrophic cardiomyopathy, characterized in that the conducting tissue Doppler study of the myocardium with subsequent determination of regional indicator strain and strain rate of the myocardium in diastole in a curved M-mode Strain Rate, perform quantitative analysis in the mode of Strain on ECG-level, and P wave count value of the deformation of the myocardium in diastole and when it is larger than 5% are diagnosed with the syndrome of incomplete diastole.



 

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The invention relates to medicine, particularly cardiology and functional diagnostics

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

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