Method for detecting cardiac coronary reserve

FIELD: medicine, cardiology.

SUBSTANCE: the present innovation deals with techniques of functional diagnostics in clinical physiology. Cardiac coronary reserve should be detected based upon applying functional interrelations between systemic circulation and coronary circulation. For this purpose it is necessary to measure patient's body weight, total oxygen intake by a patient, saturation with oxygen and hemoglobin concentration in blood samples taken out of an artery, out of right-hand atrium or right-hand ventricle, out of coronary sinus. It should be calculated depending upon hemoglobin concentration value in blood samples. The innovation suggested could be applied for prognostic evaluating the state of human cardiac activity, both in healthy persons and in patients with cardio-vascular pathology.

EFFECT: higher efficiency of detection.

2 tbl

 

The invention relates to medicine, namely to methods of functional diagnostics in clinical physiology for prognostic assessment of cardiac activity of the person, healthy and with cardiovascular disorders.

In humans and animals the amount of coronary blood flow (QC) is 4-5% of the minute volume of blood (IOC) at rest and during exercise. [Folkow B., Neal E. Circulation (TRANS. from eng.). - M.: Medicine, 1976 - 464 S. (p.15)]. Increase coronary blood flow in this ratio is due to autoregulatory mechanism (otherwise known as metabolic machine heart). It is seen as a key component of coronary flow reserve. As an active agent in this mechanism, consider adenosine, which is a derivative of actinolite (the rest of the AMP). Increase coronary blood flow metabolic machine is a natural physiological mechanism. So the real reserve of QC is to increase its stake in IOC by increasing arteriovenous difference of oxygen in the coronary vein 10-20% or increased extraction of oxygen from 74% at rest to 85% by the end of the heavy load. [Feigel E.O. Coronary Physiologyf/PhyswIogicat Rev. - 1983. - V.63. No. 1. - P.1 - 205 (pages 149 to 152)].

The use of full-scale physical activity cannot be used as a standard procedure for the evaluation of coronary flow reserve. A more acceptable procedure for this purpose was proposed with the use of digital computing angiography testirovanie the papaverine bed coronary arteries [Cusma J.T., Toggart E.J., J.D. Folts et al. Digital subtraction angiographic imaging of coronary flow reserve/Circulation I.-1987-V.75.-P.461]. However, the use of papaverine in combination with the use of sophisticated x-ray and computer technology also makes this procedure is both expensive and difficult to access.

The above-mentioned methods of assessment of coronary reserve for your application require any cumbersome procedures (physical activity), or cumbersome procedures for measuring coronary blood flow by the method of Kety - Schmidt using nitrous oxide or highly active drugs drugs type of papaverine and peridol and application of sophisticated computational and x-ray equipment. For these reasons, the evaluation of coronary flow reserve is not widely used measure in clinical physiology, whereas the need for such measurements for clinical application exists.

The above-mentioned traditional evaluation of coronary flow reserve (4-5% IOC) is not correct because it is obtained as a result of metabolic machine hearts. In this case, there is no reason to assert that the increase in coronary blood flow as its share in the value of the IOC remains the same. The poet is increased coronary blood flow should be considered in the case, if its share in the IOC will increase more than one percent.

In analytical form coronary blood flow (QC), expressed as a percentage of the IOC (QC%IOC), is given by a simple equation -

where2Cthe oxygen consumption of the heart, ml/min;OBSthe oxygen consumption of the whole organism, ml/min; HBBCthe concentration of hemoglobin in the pulmonary circulatory system, g/l; 1,355 - constant of Huffner, the amount of oxygen associated gram HB, ml/g; NVO2A- saturation of arterial blood with oxygen, %; NVO2B- oxygen saturation of the mixed venous blood of the great circle %; HBKSthe hemoglobin content in the blood of the coronary sinus, g/l; NVO2KS- oxygen saturation of blood from the coronary sinus, %. For a healthy person the oxygen consumption of the heart is calculated according to the equations for men -

and for women -

[Y.A. Vlasov, G. Okunev. etc. the Ratio between the specific oxygen consumption of the myocardium and its weight in healthy humans and patients with heart Physiology. - 1995. - T. No. 4. - Pp.92-99. (p. 94)]. For patients with cardio-vascular pathology IN2Cis calculated for other formulas [Vlaco the Y.A., Okuneva GN. The specific oxygen consumption of the myocardium in patients with congenital and acquired heart defects// human Physiology. - 2003. - T. No. 2. - S-137 (table 1)].

For men with congenital heart defects pale type (UPSBC) -

For men with congenital heart disease cyanotic type (ITSCC) -

For men with acquired heart disease (PPP) -

For women with UPSBC

For women and ITSST -

For women with PPP -

The size of the myocardial mass is calculated according to the body weight of the patient.

For men with UPSBC

For men with ITSST

For men with PPS -

For women with UPSBC -

For women with ITSST -

For women with PPP -

Get the value of2 is the equations - [2-17] has rank ál/(g·h) and reflects the value of2Cin the ground state without abbreviation, which is 27-30% of the value of the active state in the case of heart contractions. Recalculating the calculated values p2Cin the value for the working of the heart is done by the formula

The resulting value has the dimension ml/min for the whole heart.

If the HB content in mixed venous blood big circle and in the blood from the coronary sinus is the same,

In the case when it is equal to the content of HB in the big circle of blood circulation and the coronary sinus and is equal to the oxygen saturation as the mixed venous blood of the great circle, so the blood from the coronary sinus,

This corresponds to the maximum possible increase in the share of coronary blood flow in the IOC. Because under normal and pathological conditions of the share consumed by the heart of oxygen in the oxygen consumption of the whole body varies in a narrow range from 10 to 16%, then it is up to this magnitude may increase the proportion of coronary blood flow in General IOC. This will be the maximum value of coronary blood flow. [Y.A. Vlasov, G. Okunev. Circulation and gas exchange in man. The reference manual. New is Sibirsk: Science, 1992 - 320 C. (p.110; tabl); Litasov E.E., Y.A. Vlasov, G. Okunev. and other Clinical physiology artificial hypothermia. Novosibirsk: Nauka, 1997 - 564 S. (str-225; tabl)].

The difference between the maximum and the normal value of QC%IOCcorresponds to the reserve increase in coronary blood flow -

The aim of the invention is the determination of coronary flow reserve of the heart through the use of functional interdependencies between the big circle of blood circulation and coronary circle of blood circulation.

The method is as follows.

1. First measured body mass, total consumption of oxygen exasperate patient in the state of basal metabolism.

2. Diagnostic catheterization and great vessels take blood samples for gas analysis from an artery or aorta), from the right atrium or the right ventricle and the coronary sinus. Them measure the hemoglobin content, oxygen content or oxygen saturation in percent.

3. Compare the measured value of the concentration of hemoglobin in samples of mixed venous blood from the right atrium, right ventricle) and in blood from the coronary sinus. If the HB concentration in mixed venous blood ≤150 g/l, HB content in mixed venous blood and in the blood of the coronary sinus can be considered the same and for calculations use equation [26], otherwise the content of the HB is different, and for calculations you only need to use equation [1].

4. For healthy individuals as2Ccalculated according to equations [2-5] and is reduced to the dimension ml/min using equation [25], and calculate QC% IOCproduced by equations [1] or [26] depending on the values of HB concentration in mixed venous blood from the coronary sinus.

5. For patients with heart defects is calculated first weight of the heart in the body weight of the patient according to the equations [18-24], the mass of the heart is expressed in kg Then by equations [6-17] calculates the value of2Cand by the equation [25] is given by the dimension ml/min, and calculate QC% IOCproduced by equations [1] or [25] depending on the HB content in mixed venous blood.

6. According to equation [27] calculated the maximum share of myocardial consumption Of2the total consumption of the organism.

7. According to equation [28] calculate the value of coronary flow reserve of the heart.

Examples.

Table 1

The hemoglobin concentration in the artery is less than 150 g/l
Age.WeightGrowthSaturation of blood On the2 Hemoglobin,g/lTotal

IN2
IN2< / br>
heart.
Coronary reserve,%
D-C name genderYearsbody, kgCMarter.ViennaCAarterCAml/minml/min
To AO O s husband7281270,960,740,26110100,6157,3254,423,71145
TSD-VA wives18741730.960,870,35123120,4254,138,0912,7785
TSD Peninsula wives12271300,940,7050,386130131KZT 166.528,669,911579
TSD+Klesla L-husband7a 21.51250,990,750,3119114,3140,4 30,514,1676
TSD+Klesla B-n husband13371470,9420,855of 0.332126125210,640,616,52873
Pro article L-husband3473,41710,960,770,408143to 150.7244,870,818,96668
Pro article I-n husband57541570,8930,6540,446143150,8186,669,117,23147

Table 2

The hemoglobin concentration in the artery more than 150 g/l
To JSC And-husband32631650,950,760,53170191222,763,917,14016
Edgel To-Agen8a 21.51240,8930,6710,444194to 228.2128to 49.9 22,59798
Edgel M-wives15651680,8890,6350,385172194,823467,115,91525
Tetral G-husband516,8107,50,8550,6910,348158,1173,7116,936,722,15121
Tetral And husband30601630,810,630,383171193,2217,9of 89.125,63385

The method allows to evaluate the coronary reserve person.

The method of determination of coronary flow reserve of the heart, characterized in that the measuring body weight, the total oxygen consumption of the patient, taking blood samples during the sensing of the artery, right atrium or right ventricle, coronary sinus, measure the oxygen saturation and hemoglobin concentration, if the concentration of hemoglobin in the blood exceeds 150 g/l, coronary reserve of the heart (RCM) is calculated by the formula

RSC= (2C/OBS)- ((2C/OBS)×((NRBC×1,355(NVO2A-

- IEE2B)/(HB KS×1,355(NVO2A-IEE2KS))),

if the concentration of hemoglobin in the blood sample ≤150 g/l, coronary reserve of the heart is determined by the formula

RSC= (2C/OBS)- ((2C/OBS)× ((NVO2A- IEE2B)/(IEE2A-IEE2KS)),

where2Cthe oxygen consumption of the heart, which is calculated from the body weight of the patient, taking into account gender and the presence of cardiovascular disease;

INOBSthe oxygen consumption of the whole body;

HBBCthe concentration of hemoglobin in the pulmonary circulation;

NVO2A- saturation of arterial blood with oxygen;

NVO2B- oxygen saturation of the mixed venous blood of the great circle;

HBKSthe hemoglobin content in the blood of the coronary sinus;

NVO2KS- oxygen saturation of blood from the coronary sinus.



 

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1 cl, 3 ex, 1 tbl

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1 cl, 3 ex, 1 tbl

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2 ex, 2 tbl

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EFFECT: higher accuracy of diagnostics.

2 ex

FIELD: medicine; medical engineering.

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FIELD: medicine.

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