Method of determining risk of atrium fibrillation development

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to cardiology. ECG examination is performed to patient. Registration of signal-averaged ECG and transesophageal electrocardiostimulation (TE ECS) are carried out. Duration of filtered wave "P" (FiP-P) of signal-averaged ECG, dispersion of wave "P" (Pd), frequency threshold of arrhythmia induction (FTAI) and its duration are determined by means of TE ECS, risk of atrium fibrillation development (RAFD) being determined by original mathematical formula. If RAFD values are to 0.5, high during 1-3 months risk of AF development is identified. If values are from 0.5 to 1.5 - average from 3 months to 1 year risk of AF development. If values are higher than 1.5 - low, more than 1 year risk of AF development is identified after the first examination of patient.

EFFECT: method increases accuracy of determining risk of AF development after the first examination due to analysis of interaction of ECG and TEECS indices.

5 tbl, 4 ex

 

The invention relates to medicine, namely cardiology, in particular to methods for predicting the development of supraventricular cardiac arrhythmias (NDS), namely atrial fibrillation (AF).

Similar to the proposed solution is a method for predicting the development of paroxysmal AF, which consists in determining the width and amplitude, and P wave of the electrocardiogram (ECG), and when detecting, and P wave more than 0.12 s and / or amplitude of more than 2.5 mm is projected development paroxysms of these arrhythmias within a few years after the first survey (Kushakovskij MS heart Arrhythmia: a guide for physicians / Maskouski. - 3rd ed., Corr. and extra - SPb.: Folio, 2004. - 672 S.).

On the closest in technical essence as a prototype of the selected method for determining the risk of development of paroxysmal AF, which consists in determining the size or volume of the right and or left Atria, with dilatation of the Atria over 4.0 cm is determined by the risk of the development of this arrhythmia within 1-3 years and more after the first examination (Kosakowski MS heart Arrhythmia: a guide for physicians / Maskouski. - 3rd ed., Corr. and extra - SPb.: Folio, 2004. - 672 S.).

The disadvantage of analog and prototype is the lack of accuracy of determining the risk of developing AF.

The technical result of the invention is to improve the accuracy of the claim development of AF after the first examination.

The technical result of the invention is achieved by the fact that the patient spend ECG study, the registration signal-averaged ECG and transesophageal elektrocardiostimulyatsia (CPACS), then determine the duration of the filtered wave "P" (FiP-P) signal-averaged ECG, the variance of the wave "P" (Pd), the frequency threshold for induction of arrhythmia (CPIA) and its duration using CPEX and the risk of developing AF is determined by the formula: RFP=(FiP-P/Pd)×(CPIA/A), where RFP - the risk of developing AF, FiP-P - duration filtered waves "P" signal-averaged ECG in MS, Pd - dispersion wave "P" in MS, defined as the difference between the maximum and minimum values of the length of the tooth "R" when you register 12 lead standard ECG, CPIA - frequency threshold of inducing arrhythmias, defined as the product of the number of stimuli during CPEX on the duration of stimulation in minutes, And the duration of induced arrhythmia in minutes, and when the values RFP to 0.5 define high (within 1-3 months), from 0.5 to 1.5 average (from 3 months to 1 year)more than 1,5 - low (>1 year) risk of developing AF after the first examination of the patient.

The method is as follows.

The patient spend ECG study, the registration signal-averaged ECG and CPEX. Then determine Pd by standard ECG recorded is ture in 12 leads, the duration of the filtered wave "P" (FiP-P) signal-averaged ECG, CPIA and duration of the arrhythmia using CPEX. Then the risk of developing AF is determined by the formula:

RFP=(FiP-P/Pd)×(CPIA/A), where RFP - the risk of developing AF, FiP-P - duration of the filtered wave "P" signal-averaged ECG (in MS), Pd - dispersion wave "P" (in MS), defined as the difference between the maximum and minimum values of the length of the tooth "R" when you register 12 lead standard ECG, CPIA - frequency threshold of inducing arrhythmias, defined as the product of the number of stimuli during CPEX on the duration of stimulation (in minutes), And duration induced arrhythmia (in minutes), and when the values RFP to 0.5 define high (within 1-3 months), from 0.5 to 1.5 average (from 3 months to 1 year), more than 1.5 - low (>1 year) risk of developing AF after the first examination of the patient.

The essential distinguishing features of the proposed method and the causal link between them and achieve the result:

- determine the duration of the filtered wave "P" (FiP-P) signal-averaged ECG, the variance of the wave "P" (Pd), the frequency threshold for induction of arrhythmia (CPIA) and its duration using CPEX;

- the risk of developing atrial fibrillation (RFP) determined by the formula: RFP=(FiP-P/Pd)×(CPIA/A), g is e RFP - the risk of developing AF, FiP-P-duration of the filtered wave "P" signal-averaged ECG in MS, Pd - dispersion wave "P" (in MS), defined as the difference between the maximum and minimum values of the length of the tooth "R" when you register 12 lead standard ECG, CPIA - frequency threshold of inducing arrhythmias, defined as the product of the number of stimuli during CPEX on the duration of stimulation (in minutes)And the duration of induced arrhythmia (in minutes);

for RFP to 0.5 predict high (within 1-3 months), from 0.5 to 1.5 average (from 3 months to 1 year), more than 1.5 - low (>1 year) risk of developing AF after the first examination of the patient.

It is now known that the registration of excitation in the myocardium of the Atria or ventricles initiation (PV) obeys the law “flow” from one of cardiomyocytes to another (Physiology and pathophysiology of the heart: I. 1.: Per. s angl. - Under. edit Ecperiences. - M.: Medicine, 1990., Olshansky Century, Okumura K., Hess P.O., A.L. Waldo Demonstration of the area of slow conduction in human atrial flytter. // J. Amer. Coll. Cardiol. -1991. - Vol.16, N. 6. - P. 1639 - 1648., Shimisu A., Nosaki A., Y. Rudy, A.L. Waldo Multiplexing studies of effects of rapid atrial pacing on the area of slow conduction during atrial flutter in the canine pericarditis model. // Circulation. - 1991. -Vol.83, N. 3. - P.983-994.). Therefore, by direct attachment of the electrodes on the myocardium record the nature and direction of conduction is sbordone on the heart muscle. In addition, the myocardium of the Atria is cloth with rapid response, i.e. the membrane potential of the contractile fibers fibrillation is characterized by rapid depolarization (Physiology and pathophysiology of the heart: I. 1.: Per. s angl. - Under. edit Ecperiences. - M.: Medicine, 1990).

The presence of supraventricular arrhythmias, due to the fact that there had been slow and non-uniform conduction of excitation in the upper and middle parts of the Atria, which reflects the variance of the excitability of the myocardium of the Atria (Bokeria L.A. Lectures on cardiology / Lookery, Ethologica. - M., 2002. - 296 S., Braunwald's Heart Disease: a textbook of cardiovascular medicine / Ed. by P.Libby et al. - Phyladelfhia, W.B. Saunders Company, 2007. -R.), moreover, in these patients the violation of atrial conduction celebrated long before the increase in fibrillation and other predictors of AF (Federation A.V., Olesen A.I., Golub AV, Golub V. Clinical evaluation of the use of non-invasive method of determining the intra - and interatrial conduction in patients with ischemic heart disease. // Ter. archive.-1999.-№1. - P.34-39). One of the methods of detecting the presence of a dispersion of excitability of the myocardium of the Atria, the signal-averaged ECG and Pd, as well as the induction of AF by using CPEX (Olesen A.I., Shabrov AV, Razumova T.V., Alexandrov B.C. the Use of different pacing modes for selection of anti-relapse therapy paro is Sizov flicker and flutter in patients with coronary artery disease. // Ter. archive. - 2000. No. 11. - P.39-43, Braunwald's Heart Disease: a textbook of cardiovascular medicine / Ed. by P.Libby et al. - Phyladelfhia, W.B. Saunders Company, 2007. - R.).

In the proposed method, it is assumed that the presence of a dispersion of the proceedings, detected according to the signal-averaged ECG and Pd indicates that the possible development of circulation of excitation (reentry) in the myocardium of the Atria or around anatomical obstacles, for example, the motion of waves around a hollow or pulmonary veins. The induction of AF by using CPEX reflects the possibility of the development of this arrhythmia due to different trigger mechanisms (Braunwald's Heart Disease: a textbook of cardiovascular medicine / Ed. by P.Libby et al. - Phyladelfhia, W.B. Saunders Company, 2007. - R.) It should be noted that after the formation of the wave-front excitation it fractionized, divided into subsidiaries waves, each of which becomes independent, and when splitting larger waves in the local area blocked conduct or when moving towards another atrium may be formed of a critical number of stray waves required for the formation of AF, with the formation of these waves is random or "chaotic" process (M.A. Allessie, Rensma P.L., Brugada J. et al. Pathophysiology ofatrial fibrillation.// Cardiac electrophysiology. From cell to bedside. - Eds. Zipes D.P., Jalife J. - Philadelphia: W.B. Saunders, 1990. - P.548-559, M.A. Allessie, K. Konings, C. Kirchhof Mapping of atrial fibrillation. In: Ollson S.B., Allesie M.A., Campbel R.W.F., eds. Atrial fibrllation: mechanism and therapeutic strategies. Armonk, NY: Futura Publishing Company, 1994. - P.37-49). In addition, for the formation of paroxysmal AF, you must have 3 or more waves recirculation, and if the number of moving waves is reduced at least 3 - arrhythmia is terminated, which determines the duration, including induced, this arrhythmia (M.A. Allessie, K. Konings, Kirchhof Smartd of atrial fibrillation. In: Ollson S.B., Allesie M.A., Campbel R.W.F., eds. Atrial fibrillation: mechanism and therapeutic strategies. Armonk, NY: Futura Publishing Company, 1994. - P.37-49). So RRFP is an independent predictor of the development of AF, determined by a comprehensive evaluation of the predictors of AF, including the definition of its induction.

The distinctive set of essential features is new and allows to increase the accuracy of determining the risk of development of atrial fibrillation.

To illustrate the proposed method provide examples from clinical practice.

Example 1.

IB No. 1258. Patient A., 69 years old, was admitted to day care 12.07.2011, in the direction of your GP about ischemic heart disease: angina, recurrent attacks of palpitation. From the anamnesis it is known that the patient suffers from coronary heart disease: angina II functional class in the last 4-5 years. Takes Preductal MB, aspirin at a dose of 300-400 mg / day, metoprolol dose of 25-50 mg per day. In the last 3-4 months he began to notice the erratic functioning of the heart. When daily monitorirovanie and ECG, done on an outpatient basis 10.12.2004, was revealed a single ventricular premature beats with a frequency of up to 2 PVCs per hour.

In the hospital according to the clinical and instrumental examination of the patient's condition was regarded as coronary heart disease: stable angina II functional class data for the presence of "fresh" focal changes of the myocardium have been identified. The patient continued therapy Preductal MB, aspirin at a dose of 300 mg per day, enalaprilat (ednit) at a dose of 5 mg per day.

On the second day of a hospital stay is the registration was carried out ECG simultaneously in 12 standard leads, signal-averaged ECG for 5 minutes using a computer complex "Polyspectra rhythm" (firm "Neurosoft", hivanova). Then after computer processing was determined FiP-P - duration of the filtered wave "P" signal-averaged ECG (in MS) and Pd - dispersion wave "P" (in MS), defined as the difference between the maximum and minimum values of the length of the tooth "R" when you register 12 leads of the standard ECG. Patient A., 69 years FiP-P and Pd was 135 MS and 65 MS, respectively. The patient was induced AF method volley swarmcast stimulation using CPEX, and CPIA was 3 pulse/min was conducted stimulation of 30 stimuli with a duration of 6 seconds (in 0.1 min), and PE is And was calculated as the product of 30 stimuli at 0.1 min, that was 3 pulse/min). Arrhythmia were stopped on their own after 23 minutes. It should be noted that when CPEX the indicators of sinus node function, such as the restoration of sinus node function, corrected recovery time of sinus node function, time sinoatrial conduction defined according to the standard technique (Kushakovskij MS heart Arrhythmia. - L.: Medicine, 1993), did not extend beyond the fluctuations of normal values. Then was calculated RFP defined by the formula: RFP=(FiP-P/Pd)×(CPIA/A)

where RRPP - the risk of developing AF, FiP-P - duration of the filtered wave "P" signal-averaged ECG (in MS), Pd - dispersion wave "P" (in MS), defined as the difference between the maximum and minimum values of the length of the tooth "R" when you register 12 lead standard ECG, CPIA - frequency threshold of inducing arrhythmias, defined as the product of the number of stimuli during CPEX on the duration of stimulation (in minutes)And the duration of induced arrhythmia (in minutes)

Subsequently the patient was conducted therapy Preductal, aspirin, initcom (enalapril) in the doses mentioned above. Antiarrhythmic drugs were not prescribed. Spontaneous bouts of AF duration from 20 seconds to 35 minutes were is Yavlena at the daily monitoring of ECG, held the day after the above tests.

This example illustrates that when the detection values RFP 0,19 define high risk of developing AF, i.e. within 2 days after the first examination.

Example 2.

IB No. 1244. Patient S., 56 years old was admitted to hospital 21.09.2010 at the direction of the ambulance doctor about IBS: progressive angina. From the anamnesis it is known that the patient suffers from coronary heart disease: angina II functional class within the last 3 years. Takes nitrosorbid, antiplatelet agents. Two days before admission, the patient increased anginal pain frequency, duration, intensity, and changed the nature of the pain syndrome. Admission to hospital.

In the hospital according to the clinical and instrumental examination of the patient's condition was regarded as coronary heart disease: progressive angina, data for the presence of "fresh" focal changes of the myocardium have been identified. The patient continued therapy nitrosorbid at a dose of 30 mg / day, aspirin at a dose of 300 mg per day, intecom at a dose of 5 mg per day, polarizing mixture with nitroglycerin.

On the third day of a hospital stay is the nature of anginal pain stabilized.

On the third day of a hospital stay is the registration was carried out ECG simultaneously in 12 standard oted the deposits for 40 minutes using a computer complex "Polyspectra rhythm" (firm "Neurosoft", Ivanovo). Then after computer processing was determined FiP-P - duration of the filtered wave "P" signal-averaged ECG (in MS) and Pd - dispersion wave "P" (in MS), defined as the difference between the maximum and minimum values of the length of the tooth "R" when you register 12 leads of the standard ECG. Patient S., 56 years FiP-P and Pd was 132 MS and 53 MS, respectively.

Patient S., 56 years predicted the development of AF. The patient was induced AF method volley swarmcast stimulation using CPEX, and CPIA was 4 pulse/min Arrhythmia were stopped on their own after 15 minutes. It should be noted that when CPEX the indicators of sinus node function, such as the restoration of sinus node function, corrected recovery time of sinus node function, time sinoatrial conduction defined according to the standard technique (Kushakovskij MS heart Arrhythmia. - L.: Medicine,1993), did not extend beyond the fluctuations of normal values. Then was calculated RFP defined by the formula:

RFP=(FiP-P/Pd)×(CPIA/A)

where RRPP - the risk of developing AF, FiP-P - duration of the filtered wave "P" signal-averaged ECG (in MS), Pd - dispersion wave "P" (in MS), defined as the difference between the maximum and minimum values of the length of the tooth "P" when the registration is then 12 lead standard ECG, CPIA - frequency threshold of inducing arrhythmias, defined as the product of the number of stimuli during CPEX on the duration of stimulation (in minutes)And the duration of induced arrhythmia (in minutes)

Subsequently the patient was conducted therapy with nitrates, aspirin in the doses mentioned above. Antiarrhythmic drugs were not prescribed.

Spontaneous episodes of AF lasting from 15 seconds to 10 to 25 minutes were revealed by the daily monitoring of ECG 1.5 months after the above examination, and during CPACS in the same period (3 weeks after the first stimulation) CPIA was 2.6 imp/min

This example illustrates that when the detection values RFP 0,40 define high risk of developing AF, i.e. within 1.5 months after the first examination.

Example 3.

IB No. 269. Patient O., 60 years admitted to the hospital 21.01.2010, in the direction of GP CHD: first developed angina. From the anamnesis it is known that the patient had previously considered themselves healthy.

In the hospital according to the clinical and instrumental examination of the patient's condition was regarded as coronary heart disease: first developed angina, data for the presence of "fresh" focal changes of the myocardium have been identified. The patient was started care what ricardom at a dose of 40 mg per day, aspirin at a dose of 300 mg per day, tookaram 20 mg per day, polarizing mixture with nitroglycerin.

On the third day of a hospital stay is the nature of anginal pain was stopped and subsequently had anticipated.

On the third day of a hospital stay is the registration was carried out ECG simultaneously in 12 standard leads for 35 minutes using a computer complex "Polyspectra rhythm" (firm "Neurosoft", Ivanovo). Then after computer processing was determined FiP-P - duration of the filtered wave "P" signal-averaged ECG (in MS) and Pd - dispersion wave "P" (in MS), defined as the difference between the maximum and minimum values of the length of the tooth "R" when you register 12 leads of the standard ECG. Patient S., 56 years FiP-P and Pd amounted to 122 MS 61 MS, respectively.

Patient O., 68 years predicted the development of AF. The patient was induced AF method volley swarmcast stimulation using CPEX, and CPIA was 6 pulse/min Arrhythmia were stopped after 10 minutes. It should be noted that when CPEX the indicators of sinus node function, such as the restoration of sinus node function, corrected recovery time of sinus node function, time sinoatrial conduction determined obsheprinyatoye (MS Kosakowski Heart arrhythmia. - L.: Medicine,1993), did not extend beyond the fluctuations of normal values.

Then was calculated RFP defined by the formula:

RFP=(FiP-P/Pd×(CPIA/A)

where RRPP - the risk of developing AF, FiP-P - duration of the filtered wave "P" signal-averaged ECG (in MS), Pd - dispersion wave "P" (in MS), defined as the difference between the maximum and minimum values of the length of the tooth "R" when you register 12 lead standard ECG, CPIA - frequency threshold induced arrhythmias, defined as the product of the number of stimuli during CPEX on the duration of stimulation (in minutes)And the duration of induced arrhythmia (in minutes)

Subsequently the patient was conducted therapy with nitrates, aspirin, tookaram in the dosages indicated above. Antiarrhythmic drugs were not prescribed.

Subsequent monitoring during the year, including conducting daily monitoring of ECG once in 3 months, unstable paroxysmal AF duration from 15 seconds to 5 minutes have been identified within 7 months after the first examination.

This example illustrates that when the detection values RFP 1,20 determine the average risk of developing AF, i.e. within 7 months after the first examination.

Example 4.

IB No. 97. Patient K., 68 Le is, admitted to the hospital 11.01.2010 at the direction of the local doctor about ischemic heart disease: angina, recurrent attacks of palpitation. From the anamnesis it is known that the patient suffers from coronary heart disease: angina II functional class in the past 6 years. Always takes monocycle dose of 50 mg / day, aspirin at a dose of 300-400 mg / day, enalapril (Renitec) at a dose of 20 mg per day. In the last 3-4 months he began to notice the erratic functioning of the heart. When the daily ECG monitoring performed as an outpatient 10.12.2009, was revealed a single PE with frequency up to 1 extrasystoles per hour.

In the hospital according to the clinical and instrumental examination of the patient's condition was regarded as coronary heart disease: stable angina II functional class data for the presence of "fresh" focal changes of the myocardium have been identified. The patient continued therapy monocycle dose of 50 mg / day, aspirin at a dose of 300-400 mg / day, enalapril (Renitec) at a dose of 20 mg per day.

On the second day of a hospital stay is the registration was carried out ECG simultaneously in 12 standard leads for 25 minutes using a computer complex "Polyspectra rhythm" (firm "Neurosoft", Ivanovo). Then after computer processing was determined FiP-P - duration of the filtered wave "P" signal-averaged ECG (in MS) and d - the dispersion of the wave "P" (in MS), defined as the difference between the maximum and minimum values of the length of the tooth "R" when you register 12 leads of the standard ECG. Patient S., 56 years FiP-P and Pd 121 MS and 43 MS, respectively.

The patient was induced AF method volley swarmcast stimulation using CPEX, and CPIA was 17.5 imp/min Arrhythmia were stopped on their own after 12 minutes. It should be noted that when CPEX the indicators of sinus node function, such as the restoration of sinus node function, corrected recovery time of sinus node function, time sinoatrial conduction defined according to the standard technique (Kushakovskij MS heart Arrhythmia. - L.: Medicine,1993), did not extend beyond the fluctuations of normal values.

Then was calculated RFP defined by the formula:

RFP=(FiP-P/Pd)×(CPIA/A)

where RRPP - the risk of developing AF, FiP-P - duration of the filtered wave "P" signal-averaged ECG (in MS), Pd - dispersion wave "P" (in MS), defined as the difference between the maximum and minimum values of the length of the tooth "R" when you register 12 lead standard ECG, CPIA - frequency threshold of inducing arrhythmias, defined as the product of the number of stimuli during CPEX on the duration of stimulation (mine is Oh), And the duration of induced arrhythmia (in minutes)

Subsequently the patient was conducted therapy with nitrates, aspirin, initcom (enalaprilat) in the doses mentioned above. Antiarrhythmic drugs were not prescribed. Spontaneous attack the OP has evolved over 1.5 years after the examination, docked sublingual taking metoprolol dose of 50 mg as a preventive treatment of paroxysmal AF patient in addition to therapy was assigned to metoprolol dose of 100 mg per day. Arrhythmia not had anticipated for the past 2 years.

This example illustrates that when the detection values RFP 4,10 define low risk of developing AF, i.e. within 1.5 years after the first survey.

Was observed in 212 patients with coronary artery disease. All patients underwent therapy with long-acting nitrates, antiplatelet agents, angiotensin-converting enzyme inhibitors (Renitec, enalapril, Enap). Antiarrhythmic drugs were not prescribed. All patients definition RFP was held on the proposed method and according to the prototype.

Statistical analysis of the obtained results on the computer. Comparison of the accuracy of predicting the development of AF in the examined patients, defined according to the proposed method, depending on the values RFP and according about what otipo presented in table 1.

Table 1
The mapping accuracy of the development of AF in the examined patients, defined according to the proposed method, depending on the values RFP and according to prototype
RHPValues RHP
I group RFP<0,5Group II RFP - 0.5 to 1.5Group III RFP>1,5
Prediction of AF according Appl. method (number of patients)509072
AF according Appl. method (number of patients, the accuracy of the forecast)45 (90%)80 (88,89%)25 (34,72%)
Prediction of AF according to the prototype (number of patients)54565
AF according to the prototype (number of patients, the accuracy of the forecast)0 (0%)5 (11.11 per cent)15 (results were 23.08%)

50 (23,58%) patients claimed method C is achene RFP was < 0.5 (average of 0.2±0,06) (these patients were predicted to AF within 1-3 months after the first survey) (group I), 90 (ø 42.45%) is from 0.5 to 1.5 (on average 0.8±0,01) (these patients were predicted to AF within 3 months to 1 year after the first survey) (group II), and the remaining 72 patients (33,96%) >1.5 (average of 3.2±0,2) (these patients were predicted AF for more than than 1 year after the first survey) (group III).

The development of AF was observed in 45 out of 50 (90,00%) patients of the first group within 1-3 months after the first survey, 80 of 90 (88,89%) patients of group II within 3 months to 1 year after the first examination and 25 of 72 (34,72%) patients of group III more than 1 year after the first examination.

At 115 (54,25%) of all patients, i.e. 212, according to the prototype was determined RFP within 1-3 years after the examination. The 5 (2,36%), 45 (21,23%) and 65 (30.66 per cent) patients according to the prototype was determined RFP patients I, II and III groups, respectively.

AF when using prototype was not observed a single patient out of 5 I group - within 1-3 months after the first survey, the accuracy of determining RFP is 0.00%; 5 patients out of 45 group II - within 3 months to 1 year after the first survey, the accuracy of determining RFP - 11.11 per cent and 15 of the 65 patients of group III - more than 1 year after the first obledo the tion, accuracy RFP - results were 23.08%.

Comparative data on the present method and the way the prototype presented in tables 2-5.

Table 2
Definition RFP in the examined patients according to the proposed method, depending on the values RFP and according to prototype
RHPValues RHP
I group RFP<0.5 n=50Group II RFP=0.5 to 1.5 n=90Group III RFP>1.5 n=72
Definition RFP according to prototype5 (10,00%)45 (50,00%)65 (90,28%)
AF according to the proposed method45 (90,00%)80 (88,89%)25 (34,72%)

Table 3
Comparison of the accuracy of RFP patients of the first group after the first survey using the proposed method and prototype
The group of patientsThe proposed method The placeholderΔM
AndBAndB
Predictable value in %100,0090,0010,000,00+100,00%
The number of patients504550,00
Note: A - forecast B - real result of the development of AF, ΔM - accuracy RFP in comparison with the prototype.

And
Table 4
Comparison of the accuracy of RFP in patients of group II after the first survey using the proposed method and prototype
The group of patientsThe proposed methodThe placeholderΔM
AndBB
Predictable value in %100,0088,8944,4425,00+1600,00%
The number of patients9080455
Note: A - forecast B - real result of the development of AF, ΔM - accuracy RFP in comparison with the prototype.

Table 5
Comparison of the accuracy of RFP patients after the first survey using the proposed method and prototype
The group of patientsThe proposed methodThe placeholderΔM
AndBAndB
Predictable value in % 100,0034,7290,28results were 23.08+66,47%
The number of patients72256515

Note: A - forecast B - real result of the development of AF, ΔM - accuracy RFP in comparison with the prototype.

The accuracy of the method for determining RFP by the present method in comparison with the prototype within 1-3 months after the first examination increases almost 100,00% within 3 months to 1 year - on 1600,00% and more than 1 year - on 66,47%, which will ensure the timely appointment of adequate therapy.

The method of determining the risk of development of atrial fibrillation (AF) by the use of electrocardiographic (ECG) studies, signal-averaged ECG and transesophageal pacing (CPACS), characterized in that determine the duration of the filtered wave "P" (FiP-P) signal-averaged ECG, the variance of the wave "P" (Pd), the frequency threshold for induction of arrhythmia (CPIA) and its duration using CPEX and the risk of developing AF is determined by the formula:
RFP=(FiP-P/Pd)×(CPIA/A),
where RRPP - the risk of developing AF, FiP-P - duration of the filtered wave R is the signal-averaged ECG in MS, Pd - dispersion wave "P" in MS, defined as the difference between the maximum and minimum values of the length of the tooth "R" when you register 12 lead standard ECG, CPIA - frequency threshold of inducing arrhythmias, defined as the product of the number of stimuli during CPEX on the duration of stimulation in minutes, And the duration of induced arrhythmia in minutes
and when the values RFP to 0.5 define high RFP, within 1-3 months, from 0.5 to 1.5 is average, from 3 months to 1 year more than 1.5 - a low, more than 1 year after the first examination of the patient.



 

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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, 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

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