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CARDIOLOGY AND CARDIO SURGERY

INVENTION
Patent of the Russian Federation RU2180520

METHOD OF DIAGNOSTICS OF THE DISORDER OF CORONARY RUBBER

METHOD OF DIAGNOSTICS OF THE DISORDER OF CORONARY RUBBER

The name of the inventor: Shlyakhto EV; Nifontov EM; Rudomanov OG; Kazarin V.V.
The name of the patent holder: St. Petersburg State Medical University. Academician I.P. Pavlova
Address for correspondence: 197022, fil.1, St. Petersburg, ul.L. Tolstoy, 6/8, St.Petersburg State Medical University named after I.P. Pavlov, patent department, GBSakhnovskaya
Date of commencement of the patent: 2000.12.29

The invention relates to medicine, cardiology. Patients undergo stress-echocardiographic tests with transesophageal electrocardiostimulation or dobutamine. The stroke volume (VO) is recorded. With a decrease in VO at the first steps of a sample with transesophageal pacing by 30% or more compared to the initial value or with a decrease in VO at the last stages of the sample with dobutamine, a severe multivessel lesion of the coronary bed is diagnosed. Use of the proposed method allows to diagnose severe multivessel lesion of the coronary bed in patients with stable angina.

DESCRIPTION OF THE INVENTION

The invention relates to medicine, namely cardiology, and can be used to identify patients with severe multivessel lesions of the coronary bed.

A method for diagnosing the lesion of the coronary bed by conducting selective coronary angiography is known. The analysis takes into account the number of affected coronary vessels, the localization of the lesion and the depth of obstruction. Functionally significant is a stenosis equal to or greater than 75% of the artery lumen (Ricketts HJ, Abrams HL Percutaneous selective coronary cine arteriography, JAMA 181, p. 620-624 .-- August 1962). Coronarography is a direct method of diagnosing coronary artery disease and allows to diagnose all lesions of the coronary channel, including severe multi-vascular lesions, with high accuracy. However, with all advantages, the method has a number of disadvantages, the main one of which is its invasive nature and a high risk of developing various complications in the study.

A method for diagnosing coronary artery disease by conducting stress echocardiographic tests with transesophageal electrocardiostimulation or dobutamine and assessing the state of the myocardium is known (Feigenbaum H. Stress echocardiography // Sardiovasc. Imag .- 1992. - 4. - P. 13-18). The severity and extent of the lesion of the coronary bed is indirectly judged by the index of violation of local contractility of the myocardium (INLS). The magnitude of this indicator is minimal in patients with single-vessel lesions. With an increase in the number of affected vessels, the LLS is, as a rule, increasing.

However, in patients with the most severe multivessel lesion of the coronary bed, myocardial ischemia arising during exercise is widespread and leads to diffuse violations of the movement of the walls of the heart. In this case, it is not possible to localize zones of impaired contractility. Thus, when stress-echocardiographic tests are carried out, regardless of the nature of the stress agent, in such patients with the most severe coronary lesion, such an important indicator of the severity of ischemia, such as LLS, is not informative.

The invention is based on the task of creating a non-invasive method for diagnosing the lesion of the coronary bed, which makes it possible to diagnose a severe multi-vascular lesion.

This object is achieved by the fact that in a known method for diagnosing coronary artery lesions involving stress echocardiographic tests with transesophageal electrocardiostimulation or dobutamine and assessment of the state of the myocardium, the shock volume (VO) is additionally recorded according to the invention and when it decreases in the first steps of the transesophageal pacemaker By 30% or more in comparison with the initial value or decrease at the last stages of the sample with dobutamine, a severe multivessel lesion of the coronary bed is diagnosed.

The method of diagnosing coronary lesions in patients with chronic forms of IHD was developed on the basis of a survey of 68 patients with stable angina. All patients are male. The average age of the examined was 51.8 ± 0.5 years (from 28 to 68 years). Stress echocardiographic tests were performed in the morning on an empty stomach, provided that all antianginal drugs were withdrawn no less than 12 hours ( b- adrenoblockers - within 24 hours). To relieve pain during this period, nitroglycerin was used. A two-dimensional echocardiogram was performed on the "Vingmed CFM-800" device of Sonotron when carrying out the loading tests. Assessment of quantitative indices of myocardial contractility was carried out with the help of a package of specialized programs of Ecorapa. Violations of global systolic function of the left ventricle were assessed. Traditionally, the assessment of the ejection fraction (EF) is used to estimate it. Meanwhile, the determination of this parameter directly in the process of carrying out a stress-echocardiographic study is almost impossible. One of the indicators that depend on the state of the global systolic function of the left ventricle is the shock volume, the magnitude of which can be determined operatively in the study.

34 patients underwent a stress-echocardiographic test with electrocardiostimulation and 34 with dobutamine. In all patients, stress-echocardiographic sampling was supplemented with an assessment of the dynamics of VO. The striking volume was studied with the help of continuous-wave Doppler blood flow scanning in the outflow tract of the left ventricle in combination with the M-modal measurement of its magnitude. All patients underwent coronary angiography by Judkins. Criteria for diagnosis of severe multivessel coronary disease were determined on the basis of a comparative evaluation of the results of stress echocardiography and coronary angiography. When comparing coronary angiography and the results of stress echocardiographic tests, it was found that a decrease in VO by 30% or more in patients with severe multivessel coronary disease (a two-three-vessel lesion involving the anterior descending coronary artery or the main trunk of the left coronary artery) Compared with the initial value at the first stages of the test with transesophageal stimulation or its decrease at the last stages of the sample with dobutamine.

Table 1 shows the dynamics of stroke volume at various stages of the stress-echocardiographic test with transesophageal stimulation in groups with different degrees of coronary lesion; Table 2 shows the dynamics of the shock volume at various stages of the stress test with dobutamine in groups with different degrees of coronary lesion.

The method is carried out as follows

When carrying out stress echocardiographic tests with transesophageal stimulation or dobutamine according to standard protocols, the shock volume is additionally recorded before the test and at each stage of the sample. With a decrease in VO at the first stages of a sample with transesophageal stimulation by 30% or more in comparison with the initial value or a decrease in VO at the last stages of a sample with dobutamine, a severe multivessel lesion of the coronary bed is diagnosed.

The method is illustrated by the following examples.

Example 1 . Patient M. is 58 years old, suffering from stable angina of functional class II and painless ischemia. Stress echocardiography with dobutamine induced a mild anginal attack and severe depression of the ST segment on the ECG, but there were no violations of local contractility.

During the study, the values ​​of VO given in Table 1 are determined. 3-6.

Decrease in VO values ​​at stages 3 and 4 indicates a severe multi-vessel lesion of the coronary bed.

In coronary angiography, a subconjunction of the main trunk of the left coronary artery and a narrowing of the right coronary artery by 70% in the proximal part were revealed.

Example 2 . The patient K. is 62 years old, suffers from stable functional class II angina pectoris. On the ECG - a complete blockade of the left leg of the bundle of His. In the stress-echocardiographic test with dobutamine, violations of local contractility in the region of the posterior and lower walls of the left ventricle were induced, INLS = 1.32.

Values ​​of VO at the 3rd and 4th stages of the study are increased, which indicates the absence of severe multivessel lesions of the coronary bed.

Coronary angiography revealed an occlusion of the right coronary artery in the proximal part.

Example 3 . Patient M. is 55 years old, suffering from stable angina of functional class III. Stress echocardiography with transoesophageal stimulation induced an anginal attack and ST-segment depression on the ECG to 2 mm, but violations of local contractility were detected in only one segment in the left ventricular apex.

Reduction of the value of VO at 2 stages of the test by 37% compared with the initial testifies to the presence of severe multivessel lesion of the coronary bed.

In coronary angiography, the anterior descending coronary artery was narrowed by 75%, the envelope occlusion and the right coronary artery narrowing in the proximal part by 80%.

Example 4 . Patient E. 49 years old, suffers from stable angina of functional class II with rare spontaneous attacks. In stress echocardiography with transoesophageal stimulation, an anginal attack developed, accompanied by a depression of the ST segment on the ECG to 1.5 mm and a violation of local contractility in the left ventricular sidewall.

The decrease in the values ​​of VO at the 1 st stage of the test by 9.6% and 2 steps by 14% compared with the initial value indicates the absence of severe multivessel lesion of the coronary bed.

Coronary angiography revealed a narrowing of the coronary artery envelope by 70% and narrowing of the right coronary artery in the proximal part by 50%.

Use of the proposed method allows to diagnose severe multivessel coronary lesion in patients with stable angina due to additional registration of changes in stroke volume at all stages of stress-echocardiographic tests with transesophageal pacing or dobutamine.

CLAIM

A method for diagnosing coronary artery lesions by carrying out stress echocardiographic tests with transesophageal pacing or dobutamine and assessing the state of the myocardium, characterized in that the shock volume is additionally recorded and, when it decreases, at the first stages of the sample with transesophageal stimulation by 30% or more compared to the initial value Or reduction in the last stages of a sample with dobutamine, a severe multivessel lesion of the coronary bed is diagnosed.

print version
Date of publication 05.04.2007gg