Method for structure functional heart study and chronic cardiac failure diagnosis by means of high-frequency electrical impedance analysis

FIELD: medicine.

SUBSTANCE: method consists in diagnosing chronic cardiac failure. The diagnostic procedure involves using the high-frequency electrical impedance analysis. Bipolar measurements of electrical impedance of the chest involve recording average modular impedance |Z| and phase angle φ, and calculating the relation |Z|/|φ|. The measurements taken involve probing with AC current at frequencies 50, 100, 200 and 500 kHz. That implies using electrocardiographic electrodes 21 mm in diameter. The first electrode is placed in the 3rd intercostal space along the left parasternal line. The second one is placed series in three positions. For the first time, the second electrode is placed in the 2nd intercostal space along the left sternal line, lead 3-2. Then, in the 3rd intercostal space along the right parasternal line, lead 3-3. Thereafter in the 5th or 6th intercostals space on the left in a projection of apex beat, lead 3-5. Decreasing angle φ modulus at frequency 200 kHz in lead 3-2 less than 34°, and/or increasing the relation |Z|/|φ| measured at frequency 200 kHz in lead 3-3 more than 15, and/or decreasing the relation |Z|/|φ| measured at frequency 200 kHz in lead 3-5 less than 10 enable diagnosing chronic cardiac failure.

EFFECT: method increases the diagnostic accuracy ensured by measuring combined with recording the above parameters.

4 ex

 

The invention relates to medicine, namely to cardiology, and is intended to improve the accuracy of diagnosis of chronic heart failure (CHF).

The closest analogue is the method of early diagnosis of chronic heart failure (RF Patent No. 2499553 IPC A61B 5/053, publ. November 27 2013 the Authors Mishlanov V. Yu., etc.). Method for early diagnosis of chronic heart failure of the person based on the registration of the two parameters of electrical impedance of the thorax and modular values of |Z| and the angle φ is the frequency of the probing AC electric current of 100 kHz bipolar method, provided the electrodes on the surface of the chest in the III-VI intercostal space on the left and right parasternal lines. Thus the diagnosis of heart failure is carried out by calculating the ratio |Z|/|φ| and its increase more than 5 times.

The disadvantages of the prototype method are the limited range of diagnostic possibilities, namely the impossibility of diagnosing systolic heart failure, the lack of evaluation of the volumes of the chambers and other structures of the heart, which is associated with the position of the electrodes on the chest and the application of the study of the electrical impedance of only a single frequency of the probing AC electric current.

The invention is directed �and the solution to the problem of increasing the accuracy of the method and to expand the diagnostic capabilities of the method due to the diagnosis of systolic heart failure and evaluation of structural-functional state of the heart.

The problem is solved with the help of the features specified in the claims, in common with the prototype, such as a method of structural-functional studies of the heart and the diagnosis of chronic heart failure using high-frequency electrical impedance analysis using a bipolar method of measuring electrical impedance of the thorax and recording the average values of modular values of impedance |Z| and phase angle φ, the calculation of the ratio |Z|/|φ|, and distinctive essential features, such as the measurement is performed with the sensing alternating current frequencies 50, 100, 200 and 500 kHz, using electrocardiographic electrodes, with a diameter of 21 mm, the first of which is applied in the third intercostal space along the left parasternal line, and the second successively in three positions: the first time - in the II intercostal space on the left sternal line (lead 3-2, then in the third intercostal space on the right parasternal line (lead 3-3), then in the fifth or sixth intercostal space to the left in the projection of the apical impulse (lead 3-5), and by reducing the angle φ at a frequency of 200 kHz in lead (3-2) less than 34° diagnose pulmonary arterial hypertension, with increase of the ratio |Z|/|φ|, measured at a frequency of 200 kHz in lead (3-3), more than 15 are diagnosed with myocardial hypertrophy of the left ventricle, for reducing the ratio |Z|/φ|, measured at a frequency of 200 kHz in lead (3-5), less than 10 diagnosed dilatation of the left ventricle, for reducing the ratio |Z|/|φ|, measured at a frequency of 200 kHz in lead (3-5), less than 8 diagnose reduced ejection fraction of the left ventricle less than 50% and corresponding to these structural and functional changes in chronic heart failure.

The technical result of the above, the essential features is the possibility of structural and functional studies of the heart, the diagnosis of chronic heart failure and increasing accuracy.

The invention is illustrated by the following examples:

Example 1. General conditions diagnosis:

- measurement of electrical impedance of the thorax is performed bipolar method (by combining current and potential electrodes or the use of bipolar rheographic devices) the impedance Measurement is performed by the analyzer with the appropriate characteristics, for example Madass ABC-01 or other (Device for measuring impedance of biological media", Russian Federation Patent No. 2462185 from before 19.07.2011 IPC A61B 5/08, publ. 27.09.12 G. the Authors Sudakov A. I., Shakirov N. In., Zuyev A. L., Milanov V. Y.);

- electrodes mounted on the chest in the projection of the main chambers of the heart and/or major blood vessels right and left of the sternum, for example �used the first position of the electrode in the third intercostal space along the left parasternal line and the different positions of the second electrode by sternal line at the left second intercostal space (the symbol of abstraction - 3-2), parasternal line to the right in the third intercostal space (the symbol of abstraction - 3-3); in the apex of the heart in the V intercostal space to the left (callout abduction - 3-5).

- apply round the electrodes of technical steel (diameter 2.1 cm) with suction cups; measuring an electrical impedance is carried out at frequencies of the probing AC electric current from 50 to 500 kHz with simultaneous recording of modular values of impedance |Z|, phase angle φ and calculate the ratio |Z|/|φ|;

- recommended duration of measurement is not less than 1 minute with the determination of not less than 576000 values and by averaging the obtained results.

The measured values of the modular values of electrical impedance match the diameter of the large pulmonary vessels, aorta or heart chambers - the main conductors of electric current and depends on their changes in the cardiac cycle. The angle φ reflects the capacitance of the various components of the chest, primarily pleural leaflets and pericardium, consisting of dense fibrous connective tissue, and also depends on the thickness of the myocardium of the ventricles and the cellular composition of tissues. The increase in modular value of the electrical impedance |Z| corresponds to a reduction pomatiopsidae-section of a conductor of electric current - major blood vessel or chamber of the heart, according to known physical law expressed by the formula:

|Z|=XL+XC+ρ*L/S,

where XL- inductive reactance, XCcapacitive reactance, ρ is the specific active electrical resistance, L is the length of the interelectrode distance, S is the cross sectional area of a conductor of electric current.

The method is as follows. The patient is in the supine position. Electrodes with a diameter of 2.1 cm with suction cups for electrocardiographic studies made of steel technical, moisten with running water and apply on the surface of the chest in the projection of large vessels or chambers of the heart, for example, the first electrode is on the left parasternal line in the third intercostal space, and the second in II intercostal space to the left of the sternum (lead 3-2), or parasternal line in region III intercostal space right of sternum (lead 3-3), or in the projection of the apex of the heart in the fifth or sixth intercostal space to the left (lead 3-5). Start the registration of the electrical impedance at the frequency of the probing AC electric current of low power 50, 100, 200, 500 kHz and save the result in 1 minute average values of |Z| and |φ|, and calculate the ratio |Z|/|φ|. By reducing the angle φ at a frequency of 200 kHz in lead (3-2) less than 34° d�Instituut pulmonary arterial hypertension, with increase of the ratio |Z|/|φ|, measured at a frequency of 200 kHz in lead (3-3), more than 15 are diagnosed with myocardial hypertrophy of the left ventricle, for reducing the ratio |Z|/|φ|, measured at a frequency of 200 kHz in lead (3-5), less than 10 diagnosed dilatation of the left ventricle, for reducing the ratio |Z|/|φ|, measured at a frequency of 200 kHz in lead (3-5), less than 8 diagnose reduced ejection fraction of the left ventricle less than 50% and corresponding to these structural and functional changes in chronic heart failure.

Example 2

The study included 24 patients with cardiovascular diseases, including 10 men, 14 women, 3 had isolated arterial hypertension of the 2nd degree, 16 - combined for hypertension 2-3 degrees and angina 2-3 functional class, 5 - isolated angina 2 functional class. All the patients underwent echocardiography and high-frequency electrical impedance analysis of cardiac hemodynamics. The results were processed using the software package Statistica 8.0. Using correlation analysis found a significant relationship between the magnitude of the modulus of the angle φ, measured in lead (3-2) at the frequency of the probing AC 200 kHz, and the mean pressure in the pulmonary artery, r=-0,98, p=0,0027; between the value of the ratio of� |Ζ|/|φ|, measured in lead (3-3) at a frequency of 200 kHz, and the values of the thickness of the interventricular septum and the posterior wall of the left ventricle, r=0,61, p=0,0159, and r=0,71, p=0,0030, respectively; between the value of the ratio |Ζ|/|φ|, measured in lead (3-5) at a frequency of 200 kHz, and the value of the final systolic size of the left ventricle, end-diastolic size of the left ventricle, end-systolic left ventricular volume and end-diastolic left ventricular volume, myocardial mass, left ventricular mass index left ventricular myocardium, as well as the size of the ejection fraction of the left ventricle (r=-0,69, p=0,0046; r=-0,60, p=0,0187; r=-0.67, p=0,0081, r=-0,64, p=0,0133, r=-0,58; p=0,0226, r=-0,60, p=0,0173, r=0,79, p=0,0004, respectively). The sensitivity (frequency detection) reference method of diagnosis of chronic heart failure amounted to 95.8%, the new method is 100%. The above example shows that the new method for the diagnosis of heart failure exceeds the reference method for the detection rate of the disease in comparison with echocardiographic method, due to the simultaneous recording of a set of attributes, namely the reduction of the magnitude of the angle φ at a frequency of 200 KHz in the 3-2 lead less than 34° and/or increase the ratio |Ζ|/|φ|, measured at a frequency of 200 kHz in lead 3-3, 15, and/or reduce the ratio |Ζ|/|φ|, edit�bedrock at a frequency of 200 kHz in lead 3-5, less than 10.

Example 3

Patient A., aged 57. The diagnosis of coronary artery disease, myocardial infarction (2009), coronary bypass surgery (2 of shunt, 2009). OSL.: Chronic heart failure 3 f.to. (NYHA classification). Growth 169 cm, weight 65 kg, BMI of 22.8. Measured using high frequency analysis of cardiac hemodynamics values of electrical impedance of the thorax made: in the lead (3-2) at a frequency of 200 kHz, the angle φ=63,9° abduction (3-3) at a frequency of 200 kHz the ratio |Z|/|φ|=15,1, in lead (3-5) at a frequency of 200 kHz the ratio |Z|/|φ|=a 13.9. Echocardiographic method 21.12.2013. revealed: obtained were compared=16 mm Hg.CT., TSKJ=1.4 cm, ssli=1.2 cm; CEB LV=44 mm, CEB LV=32 mm, CSR LV=41 cm3, EDV LV=88 cm3, MLG=215,1 g, lvmwi=112 g/m2, LV EF=53%. Conclusion: pulmonary arterial hypertension have not been identified, signs of concentric left ventricular hypertrophy, contractility of the left ventricle satisfactory.

Example 4

Patient A., age 78; diagnosis: coronary heart disease, heart rhythm disorder type permanent tachysystolic forms of atrial fibrillation. OSL.: chronic heart failure 3 f.to. (NYHA classification). Growth 169 cm, weight 69 kg, BMI of 24.2. Measured using high frequency analysis of cardiac hemodynamics values of electrical impedance of the thorax made: in the lead (3-2) at a frequency of 200 kHz, the angle φ=62,1° abduction (3-3) at a frequency of 200 kHz �elations |Z|/|φ|=9,3, in lead (3-5) at a frequency of 200 kHz the ratio |Z|/|φ|=9,2. Echocardiographic method 21.12.2013. revealed: obtained were compared=24 mm Hg.CT., TSKJ=0.9 cm, ssli=0.8 cm; CEB LV=55 mm, CEB LV=75 mm, CSR LV=159 cm3, EDV LV=294 cm3, MLG=297,5 g, lvmwi=151,1 g/m2, LV EF=48.8 PER CENT. Conclusion: pulmonary arterial hypertension have not been identified, dilatation of the left ventricle contractility of the left ventricle is reduced.

The presented examples demonstrate the relationship of the clinical picture of the disease, accompanied by clinical signs of chronic heart failure, echocardiographic data on the availability of structural and functional disorders and altered results of electrical impedance characteristics of cardiac hemodynamics.

From the description and practical application of the present invention to specialists will be obvious and other private forms of its implementation the above description and examples are considered as material illustrating the invention, the essence of which and the scope of patent claims is defined in the following claims, the set of essential features and their equivalents.

A method for diagnosing chronic heart failure using high-frequency electrical impedance analysis using a bipolar method of measuring electrical impedance of the thorax and registration�radiation averages modular impedance values of |Ζ| and phase angle φ, the calculation of the ratio |Ζ|/|φ|, characterized in that the measurement is performed with a sensing alternating current frequencies 50, 100, 200 and 500 kHz, using electrocardiographic electrodes with a diameter of 21 mm, the first of which is set in the third intercostal space along the left parasternal line, and the second successively in three positions: the first time - in the II intercostal space on the left sternal line, the lead 3-2, then in the third intercostal space on the right parasternal line, assignment 3-3, then in the fifth or sixth intercostal space to the left in the projection of the apical impulse, abduction 3-5, and with a decrease of the modulus of the angle φ at a frequency of 200 kHz in the 3-2 lead less than 34°, and/or increasing the ratio |Ζ|/|φ|, measured at a frequency of 200 kHz in lead 3-3, 15, and/or reduce the ratio |Ζ|/|φ|, measured at a frequency of 200 kHz in lead 3-5, less than 10 diagnosed with chronic heart failure.



 

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15 cl, 8 dwg

FIELD: medicine; medical engineering.

SUBSTANCE: method involves recording multichannel electroencephalogram, electrocardiogram record and carrying out functional test and computer analysis of electrophysiological signals synchronously with multichannel record of electroencephalogram and electrocardiogram in real time mode. Superslow brain activity is recorded, carotid and spinal artery pools rheoelectroencephalogram is recorded and photopletysmogram of fingers and/or toes is built and subelectrode resistance of electrodes for recording bioelectrical cerebral activity is measured. Physiological values of bioelectrical cerebral activity are calculated and visualized in integrated cardiac cycle time scale as absolute and relative values of alpha-activity, pathological slow wave activity in delta and theta wave bandwidth. Cerebral metabolism activity dynamics level values are calculated and visualized at constant potential level. Heart beat rate is determined from electrocardiogram, pulsating blood-filling of cerebral blood vessels are determined from rheological indices data. Peripheral blood vessel resistance level, peripheral blood vessel tonus are determined as peripheral photoplethysmogram pulsation amplitude, large blood vessel tonus is determined from pulse wave propagation time data beginning from Q-tooth signal of electrocardiogram to the beginning of systolic wave of peripheral photoplethysmogram. Postcapillary venular blood vessels tonus is determined from constant photoplethysmogram component. Functional brain state is determined from dynamic changes of physiological values before during and after the functional test. Device for evaluating functional brain state has in series connected multichannel analog-to-digital converter, microcomputer having galvanically isolated input/output ports and PC of standard configuration and electrode unit for reading bioelectric cerebral activity signals connected to multichannel bioelectric cerebral activity signals amplifier. Current and potential electrode unit for recording rheosignals, multichannel rheosignals amplifier, current rheosignals generator and synchronous rheosignals detector are available. The device additionally has two-frequency high precision current generator, master input of which is connected to microcomputer. The first output group is connected to working electrodes and the second one is connected to reference electrodes of electrode unit for reading bioelectrical cerebral activity signals. Lead switch is available with its first input group being connected to potential electrodes of current and potential electrodes unit for recording rheosignals. The second group of inputs is connected to outputs of current rheosignals oscillator. The first group of outputs is connected to current electrodes of current and potential electrodes unit for recording rheosignals. The second group of outputs is connected to inputs of synchronous detector of rheosignals. Demultiplexer input is connected to output of synchronous detector of rheosignals and its outputs are connected to multichannel rheosignals amplifier inputs. Outputs of multichannel bioelectrical cerebral activity signals amplifier, multichannel rheosignals amplifier and electrophysiological signal amplifier are connected to corresponding inputs of multichannel analog-to-digital converter. Microcomputer outputs are connected to control input of lead switch, control input of multichannel demultiplexer, control input of multichannel analog-to-digital converter and synchronization inputs of current rheosignals oscillator and synchronous detector of rheosignals. To measure subelectrode resistance, a signal from narrow bandwidth current generator of frequency f1 exceeding the upper frequency fup of signals under recording is supplied. A signal from narrow bandwidth current generator of frequency f2≠ f1>fup is supplied to reference electrode. Voltages are selected and measured at output of each amplifier with frequencies of f1, f2 - Uf1 and Uf2 using narrow bandwidth filtering. Subelectrode resistance of each working electrode is determined from formula Zj=Ujf1 :(Jf1xKj), where Zj is the subelectrode resistance of j-th electrode, Ujf1 is the voltage at output from j-th amplifier with frequency of f1, Kj is the amplification coefficient of the j-th amplifier. Subelectrode resistance of reference electrode is determined from formula ZA=Ujf2 :(Jf2xKj), where ZA is the subelectrode resistance of reference electrode, Ujf2 is the voltage at output from j-th amplifier with frequency of f2, Jf2 is the voltage of narrow bandwidth current oscillator with frequency of f2.

EFFECT: wide range of functional applications.

15 cl, 10 dwg

FIELD: medical engineering.

SUBSTANCE: device has divider, comparison unit, oscillator, acoustic radiator, controllable current source, stable constant voltage source, perspiration equivalent unit, key member, illumination source, conductivity transducer having two electrodes, the first commutator, delay unit, trigger, inverter, discharge unit, the second commutator and feeding voltage availability indicator unit. The first delay unit inputs and the first commutator inputs are connected to comparison unit output. The first commutator input is connected to the first oscillator input which delay unit, trigger and inverter are connected in series. Inverter output is connected to the second input of the first and the second commutator. The first input of the second commutator is connected to the other conductivity transducer electrode and its output is connected to device body via resistor.

EFFECT: reduced current intensity passing through patient skin; excluded negative influence upon skin during prolonged operation time on patient arm during hypoglycemia attack; low power consumption.

2 cl, 4 dwg

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