Diagnostic technique for autonomic cardiac neuropathy in patients with type 2 diabetes mellitus

FIELD: medicine.

SUBSTANCE: invention relates to medicine, particularly endocrinology and diabetology. There are involved examining heart rate variability (HRV) followed by spectroscopic analysis and functional testing. Those are added with determining non-linear values: deterrent fluctuation analysis (DFA) and approximated entropy (ApEn). If observing the initial amplitude decay of the HRV spectral components - VLF less than 30 points, LF less than 15 points, HF less than 15 points, DFA more than 0.7, ApEn less than 180, lack of functional response - autonomic cardiac sympathovagal neuropathy is diagnosed. If observing the normal amplitude of the HRV spectral component -VLF more than 30 points, low LF values less than 15 points, HF less than 15 points, DFA more than 0.7, ApEn less than 180, lack of functional response LF, HF - autonomic cardiac vagal neuropathy is diagnosed. If observing the initially normal amplitudes of the HRV spectral component -VLF more than 30 points, LF more than 15 points, HF more than 15 points, DFA more than 0.7, ApEn more than 180, lack of functional response LF, HF - autonomic cardiac subclinical neuropathy is diagnosed.

EFFECT: method enables early diagnosing and typing of autonomic cardiac neuropathy for the purpose of specifying a therapeutic approach.

3 tbl, 3 ex

 

The invention relates to medicine, in particular for endocrinology and diabetology, and relates to a method of diagnosing autonomic cardiac neuropathy in patients with type 2 diabetes using spectral and nonlinear indices of heart rate variability.

Many years for the assessment of autonomic regulation in various pathological processes, including diabetes mellitus, use the method of analysis of HRV. Record R-interval is usually performed alone or when carrying out functional tests. For a detailed analysis of the vegetative status, generally used statistics.

However, the normal heart rhythm is one of the most complex physiological processes observed in nature, and the expression of this complexity simple numbers and linear equations significantly reduces the usefulness of the assessment of HRV. Analysis of HRV based on the nonlinear indicators can provide important information for the physiological interpretation of variability and assess the risk of sudden death. This addition is a promising new approaches in the diagnosis of autonomic cardiac neuropathy in type 2 diabetes. Among non-linear indices of HRV are considered to be yaytsa deranty fluctuations analysis and approximated entropy.

A known method for the diagnosis of autonomic cardiac neuropathy, based on carrying out cardiovascular reflexes (standard tests Ewing). To evaluate the activity of the parasympathetic nervous system uses the test with a deep breath. When a rare breath normal is slow pulse of at least 15 beats per minute. In the absence of the desired ischemia test is considered positive. Valsalva's test is carried out using a mercury sphygmomanometer. Simultaneously with the breath into the tube of the instrument recording the ECG. When the ratio of the longest RR cardiointervals to the shortest less than 1.2, the sample is considered positive. To assess sinteticheskoi function is used clinorotation test, during which the recorded ECG in the supine position, and then after still stay standing. This increased heart rate normally does not exceed 15 beats per minute (Svetov, Apocynin, Iguodala. Diabetic neuropathy. - M.: Medicine, 2000, s-141).

The disadvantages of this method are:

poor tolerability functional tests of elderly patients.

- lack of diagnostic and prognostic efficacy of the method as a result of the empirical approach to the study of heart rate variability.

Closest to the invention are the two which is a method for the diagnosis of cardiovascular autonomic neuropathy in patients with diabetes mellitus, suffering from chronic heart failure. The method includes recording at rest for 5 minutes with a standard deviation of intervals between normal sinus R-R-interval (SDNN). When the value of SDNN less than 33 MS is diagnosed diabetic cardiovascular neuropathy (Lstrings and other Patent RU 2336811, publ. 27.10.2008, IPC AV 5/0452).

The disadvantages of this method of diagnosis are:

1. The absence of functional testing.

2. The only statistical indicators.

The objective of the invention is the early diagnosis of the disease through the identification of signs of impaired autonomic regulation of heart rhythm in patients with diabetes mellitus type 2 and improving the quality of diagnosis by identifying three types of cardiac neuropathy.

Method for the diagnosis of autonomic cardiac neuropathy in patients with diabetes mellitus type 2, which includes a study of heart rate variability (HRV), followed by spectral analysis and by conducting functional tests, characterized in that the write slow oscillations of heart rate with registration frequency waves in the VLF ranges of 0.004 to 0.08 Hz, amplitude 30-150 points, LF 0,05-0,18 Hz, amplitude 15-25 points, HF 0.18 to 0.05 Hz, the amplitude of 15-35 points with Fourier analysis on the 5 stages of the survey: in the initial status is anii peace, mental stress, recovery after mental stress, hyperventilation stress, recovery after hyperventilation, determine the capacity of heart rate variability (HRV) in these frequency ranges, additionally determine the nonlinear indicators: getentry fluctuations analysis (DFA) of the approximated entropy (AREP), and when the initial decrease in the amplitude of the spectral components of HRV - VLF less than 30 points, LF less than 15 points, HF less than 15 points, DFA more than 0.7, AREP less than 180, areactively on functional test - diagnose autonomic cardiac neuropathy sympathovagal form; when the original normal measure of the amplitude of the spectral component of HRV - VLF more than 30 points, low values of LF less than 15 points, HF less than 15 points, DFA more than 0.7, AREP less than 180, areactively on functional tests LF, HF - diagnose autonomic cardiac neuropathy vagusnye form; when the original normal amplitudes of the spectral components of HRV - VLF more than 30 points, LF more than 15 points, HF more than 15 points, DFA more than 0.7, AREP more than 180, areactively on functional tests of components LF, HF - diagnose autonomic cardiac neuropathy subclinical form.

The novelty of the invention.

- Write slow oscillations of heart rate with registration frequency waves in the VLF ranges of 0.004 to 0.08 Hz, amplitude 0-150 points LF 0,05-0,18 Hz, amplitude 15-25 points, HF 0.18 to 0.05 Hz, the amplitude of 15-35 points with Fourier analysis on the 5 stages of the survey. Determine the capacity of heart rate variability (HRV) in these frequency ranges.

- Further define the nonlinear indicators: getentry fluctuations analysis (DFA) and the approximated entropy (AREP). The need to introduce non-linear indicators is explained a new perspective on the human organism as an open non-linear thermodynamic system. Flowing physiological processes obey the laws of deterministic chaos, small pulses at the input cause significant fluctuations in the output.

In initial decrease in the amplitude of the spectral components of HRV - VLF less than 30 points, LF less than 15 points, HF less than 15 points, DFA more than 0.7, AREP less than 180, areactively on functional test - diagnose autonomic cardiac neuropathy sympathovagal form. When the original normal measure of the amplitude of the spectral component of HRV - VLF more than 30 points, low values of LF less than 15 points, HF less than 15 points, DFA more than 0.7, AREP less than 180, areactively on functional tests LF, HF - diagnose autonomic cardiac neuropathy vagusnye form. When the original normal amplitudes of the spectral components of HRV - VLF more than 30 points, LF more than 15 points, HF more than 15 points, DFA more than 0.7, AREP more than 180 areactively on functional tests of components LF, HF - diagnose autonomic cardiac neuropathy subclinical form.

The essential features of the invention allows to obtain a new technical result. Using methods of HRV based on the analysis of spectral and nonlinear indices is early diagnosis of diabetic cardiac neuropathy diagnosis and type of autonomic cardiac neuropathy. The selection of the type of autonomic neuropathy is necessary for definition of tactics of treatment - choice antihypertensive drugs (assignment of β-blockers in case of depression of parasympathetic division of the autonomic nervous system), destination metabolic therapy (in case of suppression of both links), detection of subclinical variants of autonomic cardiac neuropathy to highlight the risk for development of this complication. So same type of Autonomous cardiac neuropathy is important to assess the prediction of sudden cardiac death.

In recent decades there have been numerous works devoted to the study of clinical and prognostic significance of heart rate variability in diabetes mellitus. The interest in the problem of autonomic cardiac neuropathy due to the fact that it is regarded as one of the adverse prognostic factors affecting the incidence of fatal cases, the pain is s.

Recent research in the field of nonlinear dynamics allow for a fresh look at various indicators of HRV. Look at the human body as an open non-linear thermodynamic system is not simply justifies and necessitates the study of nonlinear indicators (DFA, AREP).

Deranty fluctuations analysis (DFA, DFA) is one of the methods of fractal analysis of heart rate variability, analysis of the characteristics of self-similarity of time series. (Time series of a limited volume can be analyzed for similarity using the integration, if you have a certain stationarity of processes) of the correlation function must be invariant with respect to the time slots of different lengths. If not, then integration enhances the unsteadiness of the original data. To overcome this complication modified analysis by calculating the standard indicators. Deranty fluctuations analysis cannot replace any of the statistical and spectral indices.

Along with other characteristics of HRV analysis, DFA has proven informative in assessing cardiovascular variability in persons of Mature age, patients with heart disease and dilated cardiomyopathy. In Framinghammer IP is ladouanie, based on the analysis of two-hour ECG recording, it was found that DFA gives additional prognostic information compared with traditional frequency characteristics. In a retrospective comparison criteria HRV, with 24-hour ECG monitoring in patients after myocardial infarction, DFA was the most informative predictor of heart rhythm disturbances and the occurrence of apnea.

To study the features of HRV also used the indicator "approximated entropy". The physical meaning of entropy is displayed in the second law of thermodynamics. Entropy - a measure of the irreversible dissipation of energy and is a function of state of a thermodynamic system. The clinical significance of measures of disorder is high, because the loss of complexity is a sign of the presence of the disease. If the system reaches its equilibrium state (homeostasis), the entropy becomes maximum. Evaluation AREP studied in detail in cardiodynamics process. AREP reduced in neonates at risk of sudden death. Also noticed a decrease in Ara in adult patients in the postoperative period, at the risk of dysfunction ventricular myocardium in healthy individuals after administration of endotoxin, reducing heart rate.

The method is as follows.

The study variabel the spine of the heart rhythm was carried out using a 12-channel electrocardiograph "Neurosoft - polyspectra 8E".

Assessment of heart rate variability was performed using functional tests of low intensity on the methodology developed in 1994 by Professor A. Fleishman. The sequence of stages of the study are presented below:

Step 1. Check the source state (background).

Step 2. The first functional test account "in the mind" in the form of a deduction from 500 to 7 (mental load).

Step 3. The recovery phase after the first functional tests.

Step 4. The second functional test - hyperventilation.

Step 5. The recovery phase after the second functional tests.

The sample used in the method, stimulate the sympathetic division (sample 500-7) and the parasympathetic division (test with deep breathing). The data sample corresponds to an ordinary daily forms of human activity, does not cause additional emotional disorders (Antlasman. Slow hemodynamic oscillations. Novosibirsk, "Nauka", 1999, S. 38-55).

On each of the 5 stages was carried out a short account of 256 ministriesa intervals. As an additional information data was brought about blood pressure at every stage of the research. The survey was conducted in the morning (from 9 to 12 hours), at rest. The total amount of analyzed information was 1280 R-interval each time the EAC is adowanie. During visual inspection of the recorded signal were eliminated artifacts physiological or other origin. Analysis of primary data included visual analysis cardiotocogram, assessment of temporal parameters, frequency (VLF, LF and HF), energy, spectral and non-linear parameters.

Among nonlinear HRV indices were used deranty fluctuations analysis, the approximated entropy.

In the spectrum of HRV had three main components: VLF, LF and HF.

VLF - logged in the range of 0.004 to 0.08 Hz, determine the functioning of the sympathetic autonomic nervous system, the amplitude of the VLF from 30-150 points.

LF - low-frequency fluctuations reflect different sides baroreceptors functions, having in its composition as the sympathetic and parasympathetic mechanisms. Frequency range from 0.05 to 0.18 Hz, the amplitude of the LF 15-25 points.

HF - high frequency oscillation is associated with the parasympathetic nervous system is limited to a frequency range of 0.18 to 0.5 Hz, the amplitude of the HF 15-35 points.

Of the nonlinear indicators was assessed approximated entropy (norm 180-210) and getentry fluctuations analysis (0-0,5 parasympathetic predominance, from about 0.6-0.7 autonomic balance, more than 0.7 sympathicotonia).

When the initial decrease in the amplitude of the spectral components of HRV - VLF less than 30 points, LF less than 1 points HF less than 15 points, DFA more than 0.7, AREP less than 180, areactively on functional test - diagnose autonomic cardiac neuropathy sympathovagal form. When the original normal measure of the amplitude of the spectral component of HRV - VLF more than 30 points, low values of LF less than 15 points, HF less than 15 points, DFA more than 0.7, AREP less than 180, areactively on functional tests LF, HF - diagnose autonomic cardiac neuropathy vagusnye form. When the original normal amplitudes of the spectral components of HRV - VLF more than 30 points, LF more than 15 points, HF more than 15 points, DFA more than 0.7, AREP more than 180, areactively on functional tests of components LF, HF - diagnose autonomic cardiac neuropathy subclinical form.

We studied 100 patients with diabetes mellitus type 2. Depending on the amplitude (power) spectral and nonlinear indices, response to sample low-intensity defined three types of autonomic cardiac neuropathy. Vagal option sympathovagal and subclinical. Boundaries determined experimentally in statistical processing and analysis of spectral and nonlinear characteristics examined.

General characteristics of each type of autonomic neuropathy are presented in summary Table 1.

Table 1
Clinical variants autonomic cardiac neuropathy
The HRV indexSymptomology optionVagusnye optionSubclinical variant
VLF (points)*1,13±0,21,94±0,22,01±0,2
LF (points)0,46±0,100,78±0,161,17±0,2
HF (points)*0,28±0,080,72±0,101,38±0,19
reactivityno reactionSaved to "500-7"Saved to "500-7"
DFA0,95±0,10,96±0,010,83±0,09
AREP**156,1±29,7204,8±20,8217,8±28,7
*p<0,001, **p<0,001 between sympathovagal and subclinical option

When is EP 1.

Patient N. 37 years. The diagnosis of diabetes mellitus type 2, first identified. Complications - sensory polyneuropathy of upper and lower limbs.

HRV - source low variability in all departments of the spectrum of HRV - VLF - 2.91 points, LF - 2.58 points and HF - 0,26 points. Low rates approximated entropy (133-129), deranty fluctuations analysis of 0.96. When carrying out functional testing of the reaction components of the spectrum (VLF and HF) no (Table 2).

This example illustrates symptomology option autonomic cardiac neuropathy, the main characteristics of which is depression all components of the spectrum of HRV, areactively VLF, LF, HF is sampled low intensity: "500-7", an in-depth breath, the amplitude of the HF source 0,26, at the time of the in-depth breathing 0.58 points, low approximated entropy 133,5 and DFA more than 0.7 closer to 1, indicating that the relative predominance of sympathetic influences in terms of total reduction in the amplitude of all components of the HRV spectrum. When this option cardiac neuropathy is necessary to spend treatment of metabolic means, but as antihypertensive therapy appropriate designation cardioselektivee β-blockers. It is assumed low effectiveness of antihypertensive therapy, due to the loss weget the positive effects on the cardiovascular system.

Table 2
The HRV indexThe amplitude spectrum of HRV at the stage of research
12 (500-7)34 (deep breath)5
VLF (points)2,91a 12.73,289,523,99
LF (points)2,582,541,371,951,77
HF (points)0,200,340,250,580,32
AREP133,05131,41134,54127,75129,38
DFA0,960,921,06 0,830,95

Example 2.

Patient, 52 years of age.

The diagnosis of diabetes mellitus type 2, severe, compensation.

Complications of diabetic sensorimotor polyneuropathy 2-3 degree; diabetic macroangiopathy, stenosis of the crural arteries. Ischemia of the lower extremities 2 degrees.

With the debut of the diagnosis of the disease is a combination antidiabetic therapy - diabeton MB 2 tablets per day + extended insulin action (prathapan 10 units 2 times a day). After 9 months from the beginning of the disease the patient is fully translated into insulin in basal-bolus scheme, in connection with the failure of glucose-lowering therapy and long decompensation of carbohydrate metabolism. At the time of monitoring blood sugar and 7.6-5.6 mmol/l Cholesterol of 5.5 mmol/L.

When examining DIF - original normal level VLF 280,01 points, reduced the power of the right half of the spectrum of HRV - LF and HF 6,63 score of 6.96 points, respectively. The reaction colaminated rhythms on trial 500-7 according to the type of stress instability VLF source 280,01 points, when conducting the stress load is decreasing amplitude until 59,19 points. The right half of the spectrum of the LF and HF does not respond to the test with in-depth breath, the initial amplitude of the HF of 6.96 points, the in-depth breathing to 4.73 points. The initial level of the approximated entropy in the norm - 203,6, DFA Bo is her 1 (Table 3).

Table 3
The HRV indexThe amplitude spectrum of HRV at the stage of research
12 (500-7)34 (deep breath)5
VLF (points)280,0159,1915,3686,3440,09
LF (points)6,635,727,603,905,63
HF (points)of 6.961,063,794,733,44
AREP203,6of 156.6163,62176,62204,79
DFA1,21,390,96 1,211,29

This example illustrates vagusnye option autonomic cardiac neuropathy, the main characteristics of which is depression HF, normal amplitude VLF, with a normal result of the approximated entropy and DFA more than 0.7. Under this variant Autonomous cardiac neuropathy antihypertensive therapy requires the use of β-blockers with achievement of target blood pressure values.

Example 3

Patient R. 37 years.

The diagnosis of diabetes mellitus type 2, compensation.

Complications of diabetic nephropathy in the stage of proteinuria, diabetic polyneuropathy of the lower extremities.

Blood sugar is a 4.7-7.8 mmol/l Compensation of carbohydrate metabolism achieved by taking tablets hypoglycemic funds. Blood pressure does not rise.

Cholesterol 4.8 mmol/L.

HRV original average level of variability with normal autonomic profile. VLF - 89.2 points, LF - 10,46 points, HF - 25,67 points. Saved response colaminated rhythms to stress-test VLF source of 89.2 points to stress-test the capacity increase with the rise of the amplitude up to 102.2 points. The low reactivity of the right half of the spectrum for the sample with in-depth breath, that is not normal in healthy people. Noteworthy uncharacteristic of vegetative balance pok is a pointer DFA more than 0.7, that speaks of subclinical disorders of regulation of HRV. Satisfactory performance of the approximated entropy 207,23 (Table 4).

202,04
Table 4
The HRV indexThe amplitude spectrum of HRV at the stage of research
12 (500-7)34 (deep breath)5
VLF (points)89,2102,2460,9654,3767,25
LF (points)10,468,438,7132,6212,77
HF (points)25,6712,6713,7915,41to 10.62
AREP207,23191,99210,94215,05
DFA0,710,750,770,610,83

This example illustrates subclinically option autonomic cardiac neuropathy, the main characteristics is the source of the normal amplitude of all components of the spectrum of HRV VLF more than 30 points, LF more than 15 points, HF more than 15 points and the normal performance of the approximated entropy over 180, but the value DFA more than 0.7, which is a predictor of the development of autonomic cardiac neuropathy, and requires monitoring of the HRV indices. Appointed metabolic therapy of α-lipoic acid and vitamin C.

Thus, the proposed method is easy to use and vasocontriction, the sensitivity of the method is quite high and exceeds similar ways. The claimed invention will allow for the diagnosis of autonomic cardiac neuropathy in diabetes mellitus type 2.

The selection of autonomic neuropathy type allows you to define the tactics of treatment is the choice of antihypertensive drugs (assignment of β-blockers in case of depression of parasympathetic division of the autonomic nervous system), the appointment of metabolic therapy (in case of suppression of both star is Lev), detection of subclinical variants of autonomic cardiac neuropathy to highlight the risk for development of this complication.

Method for the diagnosis of autonomic cardiac neuropathy in patients with diabetes mellitus type 2, which includes a study of heart rate variability (HRV), followed by spectral analysis and by conducting functional tests, characterized in that the write slow oscillations of heart rate with registration frequency waves in the VLF ranges of 0.004 to 0.08 Hz, amplitude 30-150 points, LF 0,05-0,18 Hz, amplitude 15-25 points, HF 0.18 to 0.05 Hz, the amplitude of 15-35 points with Fourier analysis on the 5 stages of the survey: in the initial state of rest, mental stress, recovery after mental stress, hyperventilation load, recovering from hyperventilation, determine the capacity of heart rate variability (HRV) in these frequency ranges, additionally determine the nonlinear indicators: getentry fluctuations analysis (DFA), the approximated entropy (AREP), and when the initial decrease in the amplitude of the spectral components of HRV - VLF less than 30 points, LF less than 15 points, HF less than 15 points, DFA more than 0.7, AREP less than 180, areactively on functional test - diagnose autonomic cardiac neuropathy sympathovagal form; when the original normal measure of the amplitude of the spectral components is enta HRV - VLF more than 30 points, low values of LF less than 15 points, HF less than 15 points, DFA more than 0.7, AREP below 180, areactively on functional tests LF, HF - diagnose autonomic cardiac neuropathy vagusnye form; when the original normal amplitudes of the spectral components of HRV - VLF more than 30 points, LF more than 15 points, HF more than 15 points, DFA more than 0.7, AREP more than 180, areactively on functional tests of components LF, HF - diagnose autonomic cardiac neuropathy subclinical forms.



 

Same patents:

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to neurology, therapy, family medicine, and can be used for selection of tactics for treatment of tension headache. For this purpose level of peripheral heart vegetative balance is determined in patient by analysis of index of sympathetic-parasympathetic relationship (LF/HF) in spectral analysis of cardiac rhythm. If LF/HF index increases higher than 2.0 conv. units, psychotropic drugs are introduced into therapy for relief of anxiety and/or depression.

EFFECT: method ensures possibility to stratify patients, requiring introduction of psychotropic drugs, thus making it possible to optimise treatment and increase its efficiency due to account of individual peculiarities of heart vegetative balance.

3 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to neurology and hepatology. Multi-level neurodynamic analysis of cardiorhythmograms is registered and realised by means of rhythmocardiograph and hardware and software complex "Omega-C". Determined are indices, reflecting: "A" - association of all, but mainly peripheral rhythmic processes, "B1" - degree of equilibration of sympathetic and parasympathetic effects on sinus node of heart, "C1" - state of central subcortical regulation, "D1" - state of central cortical regulation. Diagnostics index (YHE-L) is calculated in patients with chronic liver diseases by formula: YHE-L= -1.5 + 0.003*A + 0.013*B1 + 0.006*C1 + 0.053*D1. If YHE-L value is from -0.47 to 0.49, hepatic encephalopathy of latent stage in patients with chronic liver diseases is determined.

EFFECT: method makes it possible to increase reliability of diagnostics of hepatic encephalopathy of latent stage.

8 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention refers to occupational medicine. Individual state and performance values are estimated by four-score scale. Zero points if no symptoms observed, 1 point - the symptom is slightly manifested, 2 - moderately, 3 - significantly. A fatigue index (FI) is calculated as an arithmetic mean value. Electrocardiography is recorded to estimate cardiac rhythm variability, to calculate Am, Si, LF, heart rate. A modification coefficient (M) is calculated for each value by formula: wherein Ai is a value of one of the following signs, Amax and Amin are change ranges; : Am min 3.5, Am max - 98; Si min - 2, Si max - 950; LF min - 5, LF max - 90; heart rate min - 40, heart rate max -120; a vegetative regulation index (VRI) is calculated by formula: If the FI value is 0.6 points or less, and the VRI value is 10 or less, the state is considered to be optimal; the FI value 0.6 points or less and the VRI value more than 10 show the borderline state; the FI value more than 0.6 points and the VRI value is 10 or less means the satisfactory state; while the FI value exceeding 0.6 points and the VRI value exceeding 10 providing stating defatigation.

EFFECT: method extends the range of products for detecting defatigation in operators.

7 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely cardiology, normal physiotherapy, pathological physiotherapy. A daily curve of blood pressure is recorded. It is followed by spectral analysis by the method of continuous wavelet transformation. A frequency power of the blood pressure curve a is determined in the moment b by mathematical formula. Scalograms are drawn on the basis of the wavelet coefficient on the segment [bj, bj] by mathematical formula. Physiologically relevant frequency ranges are selected at the scalograms on the basis of distances between adjacent local minimums on the scalogram curve by formula.

EFFECT: method provides weak influence of vegetative nervous system and humoral effects on the blood pressure curve at the various stages of ontogenesis, in health and disease, both in rest, and in transition processes.

1 ex, 2 dwg

FIELD: medicine.

SUBSTANCE: invention refers to rehabilitation and preventive medicine, cardiology, therapy. It involves drug-induced therapy and a course of cardiorespiratory training with biological feedback (BF) presenting a cardiorhythmography (CRG) and a reference cyclic curve (RCC) to the patient to be matched under continuous visual control. It is followed by active (BF-assisted) and non-active (BF-unassisted) 2-minute tests with the first and last test of each session are non-active (NT). The first NT involves recording reference data of patient's cardiorespiratory system with evaluating the parameters as follows: RCC amplitude, period and continuous component matched with average heart rate on the following active test (AT). The test are automatic, individual for the patient as for the moment of testing with the use of an apparatus for functional psychophysiological correction comprising units described in the patent claim. Each following AT requires forming RCC with the use of average heart rate, amplitude and period on the basis of spectral analysis of CRG and CC of the previous AT. In the beginning of the procedure, the patient is set up to successful completion of the task, 5 s after the beginning of each AT, an audio signal (1 kHz, 300 ms, 30 dB above a threshold of audibility) is supplied. Before the beginning of the course and after each session and the whole course, the patient is tested to determine a level of reactive and personal anxiety and depression by stating the required number of sessions for recovery of cardiorespiratory synchronisation and normal heart rate and blood pressure. Before the first NT and after each AT, capnometry is used to determine the concentration of CO2 in expired air. If observing decrease, respiratory depth is corrected. If maintaining CO2 in expired air after each following AT less than 95% from reference, respiratory depth is corrected during the following AT under control of capnometry to achieve the concentration of not less than 95% from reference. The therapeutic course includes at least 5 sessions, 1 session daily or every second day to recover the respiratory pattern lost due to the disease and the biorhythmological structure of heart rate.

EFFECT: method eliminates subjectivity of the respiratory parameters specified by a searcher, and hyperventilation syndrome due to objective control of respiratory depth with improved heart rate variability.

1 ex, 3 tbl, 3 dwg

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine and medical equipment, namely, to systems of image obtaining, in particular, to computed tomography. In first version of implementation system of image obtaining contains component of window management, which receives ECG signal, which contains premature cardiac cycle and preliminarily obtained X-ray projection data of beating heart. ECGF signal is synchronised with the time of preliminarily obtained X-ray projection data of beating heart. Component of window management places first reconstruction window within the limits of the first cardiac cycle to correspond desirable cardiac phase of preliminarily obtained X-ray projection data, when premature cardiac cycle ensures correspondence of the first reconstruction window to another cardiac phase. Such system contains device of reconstruction which reconstructs projection data, corresponding to multitude of windows of reconstruction of different cardiac cycles to create image data, characteristic of desirable heart phase. In second version of implementation system contains component of window management which deletes first reconstruction window corresponding to suboptimal cardiac phase of preliminarily obtained X-ray projection data of beating heart resulting from abnormal signal in ECG signal. ECG signal is presented in time with preliminarily obtained X-ray projection data of beating heart on multitude of heart cycles, and component of window management adds replacing reconstruction window to optimise set of data for reconstruction, basing on abnormal signal and available preliminarily obtained projection. System also contains reconstruction device which reconstructs set of data for reconstruction in order to create image data characteristic of desirable phase of heart beating. In third version of implementation system contains recommendation component which recommends reconstruction window for cardiac phase within the multitude of preliminarily obtained successive cardiac cycles based on ECG signal and arrhythmia in it, and device of reconstruction, which reconstruct data corresponding to data for each cycle, corresponding to reconstruction window. ECG signal is obtained with simultaneous scanning of beating heart by of computed tomographic scanner. In fourth version of implementation system contains component of window management which automatically changes location or moves first window of reconstruction for cardiac cycle on the basis of premature cardiac cycle within ECG, which is signal synchronised with preliminarily obtained X-ray projection data of beating heart; recommendation component which automatically recommends, at least, one additional reconstruction window, on the basis of premature cardiac cycle; and reconstruction device which reconstructs data, corresponding to reconstruction windows. In order to obtain image received is ECG signal which contains premature cardiac cycle, ECG signal is synchronised in time with preliminarily obtained X-ray projection data of beating heart by multitude of cycles of heart beating. After that, first reconstruction window is moved within the limits of first cardiac cycle, which corresponds to data, different from desirable cardiac phase as a result of premature cardiac cycle. Each from multitude of cardiac cycles contains reconstruction window. Then preliminarily obtained projection data, corresponding to multitude of reconstruction windows, are reconstructed to create image data, characteristic of desirable phase of heart beating. Group of inventions also contains computer-readable data carrier, which stores commands, which, when performed by computer, make computer perform claimed method of image obtaining.

EFFECT: application of claimed group of inventions will make it possible to increase quality of resulting data of reconstructed image.

34 cl, 10 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to pediatrics. In children of pre-school age with tuberculosis of intrathotacic lymph nodes indices of heart rhythm variability are determined: rhythmograms - interinterval differences RMSSD (ms), coefficient of variability CV (%), spectrograms - total spectrum power TR (ms2), very low frequency waves of spectrum VLF (ms2), low frequency waves of spectrum LF (ms2), high frequency waves of spectrum HF (ms2). If their values equal: interinterval differences RMSSD - 76.8±3.92, coefficient of variability CV - 9.9±0.50, total spectrum power TR - 3437±175.3, very low frequency waves of spectrum VLF - 1067±54.4, low frequency waves of spectrum LF - 1003±51.2, high frequency waves of spectrum HF - 1900.2±96,9 vegetative dysfunction is diagnosed.

EFFECT: method increases reliability of diagnostics of impairment of vegetative regulation in children with tuberculosis.

1 tbl, 1 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to pediatrics. Parameters of cardiorhythmogram (CRG) are registered in lying position: at rest - heart rate, SDNN index; tension index (TI); total spectrum power - Total; value of power in range VLF; value of power in range LF; value of power in range HF. After that in standing position reactivity of sympathetic nervous system is determined by Lf/HF index. In five minutes in lying position recovery of initial heart rate, total spectrum power - Total, increase or reduction of initial power in range of waves: VLF, LF, HF are determined. On the basis of CRG indices, it is estimated which type of cardiac rhythm regulation level prevails: reflex or humoral-metabolic; vegetative balance of sympathetic and parasympathetic impact on cardiac rhythm; reactivity of sympathetic nervous system to functional load: adequate or inadequate. Favourable adaptation is predicted if reflex type of cardiac rhythm regulation prevails over humoral-metabolic, at rest balance of sympathetic and parasympathetic impact on cardiac rhythm is determined, under functional load adequate reactivity of sympathetic nervous system is observed. Unfavourable prediction of adaptation is made if reflex type of cardiac rhythm regulation prevails, but at rest sympathetic or parasympathetic impact on cardiac rhythm is observed, under functional load adequate or increased reactivity of sympathetic nervous system is observed. Unfavourable prediction is made if humoral-metabolic type of level of cardiac rhythm regulation prevails, at rest sympathetic impact on cardiac rhythm prevails and under functional load - inadequate: increased or reduced reactivity of sympathetic nervous system is observed.

EFFECT: method makes it possible to increase reliability of prediction of children's adaptation school.

4 tbl, 3 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, pulmonology and perinatology. A pregnant woman suffering bronchial asthma of slight severity, in an attack-free period is examined for the functional state of the vegetative nervous system by cardiorhythmography. Detecting a prevailing effect of the sympathetic nervous system by regional lung rheography technique is used to determine a degree of involvement (%) of a medium region of a left lung in air fill (DOmrll%) and a pulse wave propagation time between the heart and the medium region of the left lung (gamrll). It is followed by a discriminant equation: D=-0.054×DOmrll%-11.781×gamrll. If the value D is equal to or more than -2.55, a baby in a in satisfactory condition is expected to be born, while D being less than -2.55, a baby in asphyxia is predicted.

EFFECT: method provides higher prediction reliability.

1 ex

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine, namely to methods of heart functional state diagnostics. Cardiorhythmogram is registered, integral and amplitude parameters are determined, their phase characteristics are fixed. As position of phase characteristics vector changes, building of elementary geometric figures of said vector travel on phase plane is carried out. From obtained building of elementary geometric figures number of geometric figures with sides '2', '3', '4',…'15', as well as number of elementary figures "point", reflecting zero increments of R-R cardiointervals are determined, plotting them on diagram of ratings of elementary geometric figures as "1". Presence of pathology is determined if value of number of said figures is higher than 3% from total number of figures.

EFFECT: method extends arsenal of means for control of heart functional state.

14 dwg, 4 tbl

FIELD: medicine, cardiology.

SUBSTANCE: one should register rhythmocardiogram, measure current total power in low-frequency and high-frequency areas of dynamic row of cardiointervals. Evaluation of psychophysiological state should be performed by the value of stress index S calculated due to original mathematical formula by taking into account the power of low-frequency and high-frequency constituents of the range of dynamic row of cardiointervals. In case of standard conditions of measurement - the rest lying at one's back position the value of S stress index should be considered to be equal to 1. The method enables to rapidly and noninvasively detect and range human psychophysiological state.

EFFECT: higher accuracy of evaluation.

2 dwg, 1 ex, 2 tbl

FIELD: medicine.

SUBSTANCE: method involves estimating vegetative tonus using cardiointervalography approach and its medication adjustment under cardiointervalography control. The cardiointervalography examination is carried out before applying treatment, in the course of and after the treatment. Each time vegetative tonus increment is estimated on the basis of voltage index. When applying medication adjustment, nootrop group preparations are used that are selected before applying treatment with initial vegetative tonus disorder distinguished by vagotonia or sympathicotonia being taken into account. Preparation or combination of preparations or their doses and application duration is adjusted on basis of vegetative status direction changes obtained from cardiointervalography examination data. The treatment is continued until vegetative status direction change stops towards normotonia.

EFFECT: enhanced effectiveness in selecting individual treatment course.

3 cl, 3 dwg

FIELD: medicine.

SUBSTANCE: method involves recording rhythmocardiogram. Then, spectral analysis of RR intervalogram components in frequency bandwidth from 0.04 to 0.4 Hz is carried out and information value Z is determined from formula Z=Ahf/Alf, where Ahf is the maximum of high frequency component in bandwidth from 0.14 to 0.4 Hz, Alf is the minimum of high frequency component in bandwidth from 0.04 to 0.14 Hz. Z value being greater than 45 and lower than 14, persons consuming narcotic drugs are detected. Z value being lower than 14, persons consuming sedative drugs like opium, morphine, heroine are detected. Z value being greater than 45, persons consuming psychostimulating drugs like cocaine, amphetamine, efedrone, sydnocarb are detected.

EFFECT: high reliability of screening study data.

4 cl, 6 dwg

FIELD: medicine, diagnostics.

SUBSTANCE: the method deals with monitoring the difference in signals obtained from N pickup units, where N ≥ 2, ECG, pulse, temperature and analysis of the range and variability of their rhythms, nonlinear chaotic fluctuations during the period of registration. During analysis one should detect the values for fractal dimensions of Hirst's index and informational Fischer's index standardized, correspondingly, by the average value during either nocturnal or diurnal period. One should conclude upon improved body state by the normalization of signals' difference of peridiurnal rhythm, increased fractal dimensions, Hirst's index, decreased standardized informational Fischer's index, and one should conclude upon worse physiological or pathophysiological processes according to the opposite alterations. The method enables to widen functional possibilities during diagnostics.

EFFECT: higher accuracy of diagnostics.

3 dwg, 6 ex

FIELD: medicine; cardiology.

SUBSTANCE: electrocardiogram of patients with arterial hypertension is subject to twenty-four-hours monitoring. Spectral analysis of variability of heart beating is conducted and low-frequency, very low frequency and high frequency wave components of heart beating are selected. Strength of wave components of heart beating is determined as general, day and night ones. Generalized factor W is calculated by original relation. Value of W is used for diagnosing absence or presence of hormone-active hyper-plastic process of adrenal glands.

EFFECT: screening testing at out-patient conditions.

2 ex, 2 tbl

FIELD: medicine; cardiology.

SUBSTANCE: electrocardiogram of patients suffering from arterial hypertension is subject to twenty-four-hours monitoring. Spectral analysis of variability of heart beating is carried out. Very low frequency, low frequency and high frequency wave components are selected. General, day and night strength of wave components of heart beating is determined. Any factor is estimated according to the data taken from the spreadsheet. Generalized factor Z is calculated by original mathematical relation. Value of Z is used for judging on level of influence of hormones of adrenal gland onto pace-maker activity of sinus node.

EFFECT: comfort at usage; higher efficiency at non-invasive application.

2 ex, 2 tbl

FIELD: medicine; functional medicine.

SUBSTANCE: method in based upon remote irradiation of human body with set of super wide-band electromagnet pulses with duration of 0,2-1,0 ns, repetition rate of 0,05-30,0 MHZ and average density of flow of energy at irradiated part of human body being equal or less than 0,2 mcW/cm2. Modulation component of pulse repetition rate is selected from received reflected signal which pulse repetition rate is determined by heart activity, which is used for forming heart beat rate signal. The latter is used additionally for estimating index of stress which value of index of stress is included into transmitted communication message of mobile phone.

EFFECT: prolonged monitoring of functional condition of human.

3 cl, 2 dwg

FIELD: medicine, cardiology.

SUBSTANCE: one should register a rhythmocardiogram, detect spectral values for variability of cardiac rhythm, calculate the value of autonomic index, calculate the value of autonomic tonicity by the following formula: AI/lnTp m sq. sec., where AI - autonomic index, lnTp - total power for the spectrum of variability of cardiac rhythm. At values above 3.1 one should diagnose severe flow of autonomic dystonia syndrome, at values being 3.1-2.2 - moderate flow of the mentioned disease, at values ranged 2.1-1.5 - light flow. The method enables to predict the development of hemodynamic disorders.

EFFECT: higher efficiency and accuracy of diagnostics.

3 ex

FIELD: medicine; cardiology.

SUBSTANCE: device for processing intervals of electrocardiogram has plate with Q-T (J-T) and R-R scales applied onto the plate. Plate is additionally provided with legs, rod and scale pointer at the end, arrows, and catches disposed at ends of Q-T (J-T) scale, Q-Tc (J-Tc) correlated values curves and Q-Tc (J-Tc) scale related to them. Rod is divided by axis to parts to relate as 1:5 in such a way that shorter part of rod has to be movable leg and longer part has to be the pointer of Q-T (J-T) scale. Pointer takes "0" position of Q-T (J-) scale to rest against left catch when legs close up. Motionless arrow is disposed onto longer part of rod under pointer of Q-T and/or J-T scale at level of "0" position of R-R scale. Slider with lock is mounted onto pointer to move along pointer. Slider is provided with two arrows. Formulas for building curves of Q-Tc (J-Tc) corrected values are given.

EFFECT: higher speed and comfort at processing of electrocardiograms.

3 cl, 8 dwg, 1 tbl

FIELD: medicine, electrocardiography.

SUBSTANCE: the present innovation deals with measuring parameters of electrocardiosignal (ECS) ST-segment and their analysis to detect deviations against the norm. At every step of quantization one should form the readings of first-order differences and modules of first-order differences. One should memorize N of readings for the modules of first-order differences coming after ECS readings that correspond to the onset of cardiocycle. Then it is necessary to sum up memorized values of modules and at every step of quantization one should compare the obtained current sum value with previous one. It is necessary to memorize the greater of them and according to maximal value one should form threshold level to compare current value of modules sum. Time moments when sum value is at first greater and then lower against threshold level one should consider to be, correspondingly the onset and the end of ST-segment. Time segment between the onset and the end of ST-segment should be considered as duration of ECS ST-signal. Device to isolate ECS ST-signal on-line contains a block for forming ECS, a block for primary ECS processing, a quantization block, a block for isolating the point of cardiocycle onset and measurement of its duration, a block to form first-order differences, a block to form modules of first-order differences, a block to memorize readings for the modules of first-order differences, a block to detect the number of summarized readings for the modules of first-order differences, a summarizing block, a block to form a threshold level, a block for comparison and a key device. The innovation enables to isolate ST-segment more reliably for wider class of electrocardiograms at different modifications of QRS-complex form.

EFFECT: higher efficiency.

2 cl, 12 dwg

Up!