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INVENTION
Patent of the Russian Federation RU2160052
METHOD FOR DETERMINING THE LOCALIZATION OF FRONT STENOS
INTERGENDRICAL ARTERY OF THE HEART
The name of the inventor: Ponomarev SB; Leschinsky LA; Petrov AG; Rusyak IG; Farkhutdinov AF; Romanova Z.D.
The name of the patent owner: Sergey Borisovich Ponomarev
Address for correspondence: 426057, Izhevsk, PO Box 25, Ponomarev S.B.
Date of commencement of the patent: 1998.06.01
The invention relates to medicine, in particular to cardiology, and can be used to determine the location of stenosis of the anterior interventricular artery. In the course of pharmacological stress echocardiography, zones of asynergia are identified using the 16-sector mapping method. The lesion of the anterior interventricular artery is determined at three sites using prognostic coefficients. By their magnitude, the prediction of the presence of stenotic lesion of the examined artery sites is made. The method allows to determine the exact localization of stenosis.
DESCRIPTION OF THE INVENTION
The invention relates to medicine, in particular to cardiology, and can be used to determine the localization of stenosis of the anterior interventricular artery based on pharmacological stress-echocardiography data.
A method for determining stenotic heart vessels is known by analyzing echocardiography data during bicycle ergometry, which consists in determining the contractility of myocardial segments during exercise (see Cardiology, N 2, 1996, p. 62).
The disadvantage of the known method is that it does not allow to reveal the exact localization of stenosis, i.e. In this way, only the presence of an artery lesion can be determined, but it is impossible to determine the exact localization of the lesion.
Known is the way we took for the prototype (Schiller N. Clinical echocardiography .- Moscow: Nauka, 1993, pp. 236-248). The method consists in the following: after carrying out pharmacological stress echocardiography, an analysis is made of the localization of the detected sites of myocardial asynergy, on the basis of which a conclusion is made about the stenotic lesion of the anterior interventricular artery of the heart (left anterior descending coronary artery).
The disadvantage of the prototype is that with its help it is possible to determine only the artery afflicted with atherosclerosis, but it is impossible to determine the exact localization of stenosis.
The essence of the claimed invention lies in the fact that according to the method for determining the localization of stenosis of the anterior interventricular artery of the heart, including pharmacological stress echocardiography and determination of the lesion of the anterior interventricular artery, the lesion of the anterior interventricular artery is determined on three sites using formula
On the upper section:
K = 0.148 + 0.144X1 + 0.129X2-0.266X3 + 0.24X5 + 0.163X7 + 0.24X9-0.134X11
In the middle section:
K = -0.49 -0.202X2 + 0.415X4 -0.45X5 + 0.192X6 + 0.287X8 -0.125X9 -0.206X10 + 0.261X11 + 0.063X12-0.164X13
On the distal segment:
K = -0.597 - 0.145X1 + 0.084X3 - 0.234X5 + 0.115X7 - 0.118X9 + 0.083X10 + 0.114X11 + 0.212X12 + 0.091X14,
Where K is the prognostic factor
X1 - Asynergia in the A Base segment
X2 - Asynergia in the AL Base segment
X3 - Asynergy in the IL Base
X4 - Asynergia in the I Base segment
X5 - Asynergia in the IS Base segment
X6 - Asynergia in the AS Base segment
X7 - Asynergia in the A Mid Segment
X8 - Asynergia in the AL Mid segment
X9 - Asynergia in the IL Mid segment
X10 - Asynergia in the I Mid segment
X11 - Asynergia in the IS Mid segment
X12 - Asynergia in A segment Apex
X13 - Asynergia in the segment L Apex
X14 - Asynergia in the segment I Apex
And the value of X for each of the considered segments is assumed to be +1 in the presence of asynergy and equal to -1 if it is absent and at a value of K i 0, the presence of stenotic lesion of the examined artery site is predicted, and for K <0, the absence of lesion is predicted.
Use of the claimed invention will improve the accuracy of localization of stenosis of the anterior interventricular artery.
The method is carried out as follows.
During the pharmacological (as a drug agent used dipyridamole or dobutamide) stress echocardiography, the detection of zones of asynergia by the method of 16-sectoral mapping, proposed by the American Association of Echocardiography.
Then, the localization of stenoses of the anterior interventricular artery is determined in three of its sections with the calculation of the prognostic coefficient K according to formulas
On the upper section:
K = 0.148 + 0.144X1 + 0.129X2-0.266X3 + 0.24X5 + 0.163X7 + 0.24X9-0.134X11
In the middle section:
K = -0.49 -0.202X2 + 0.415X4 -0.45X5 + 0.192X6 + 0.287X8 -0.125X9 -0.206X10 + 0.261X11 + 0.063X12-0.164X13
On the distal segment:
K = -0.597 - 0.145X1 + 0.084X3 - 0.234X5 + 0.115X7 - 0.118X9 + 0.083X10 + 0.114X11 + 0.212X12 + 0.091X14
And the magnitude of the coefficient K predicts the localization of stenosis of the anterior interventricular artery. The value of X for each of the segments under consideration is taken to be +1 if there is an asynergy and equal to -1 if it is absent (the segment designation is made in accordance with the international classification) and at a value of K = 0, the presence of a stenotic lesion of the section of the artery is predicted, and if K < 0 predict the absence of defeat.
In the training group, 90 patients with proven coronary artery disease under the World Health Organization criteria were included in the formulation of the prognostic coefficient formula. All patients underwent standard pharmacological stress echocardiography on COMBISON-320 and SONOS-100 a devices and selective coronaroangiography performed transfemoral according to the Jadkins method. When stress-echocardiography was performed, the occurrence of violations of myocardial contractility in a 16-segment system of left ventricular mapping was recorded. During coronary angiography, stenotic lesions of the arteries with respect to various parts of the coronary circulation system were noted. Adapted for cybernetic processing data on patients were introduced into the computer. The calculations were made with the help of the method of least squares (Linnik, Yu.V., The least squares method and the fundamentals of the mathematical-static theory of processing observations, Moscow: Fizmatgiz, 1962). As a result of the calculations, formulas were obtained to determine the exact location of stenoses in the system of the anterior interventricular branch of the left coronary artery. The results were tested in an independent control group consisting of 50 patients with coronary artery disease who underwent the same studies as those in the treatment group. It was found that the correspondence of the expected and actual localization of stenosis corresponded to 82% for the upper part of the anterior interventricular artery, 78% for the middle and 84% for the distal department.
Example 1 . Patient A. He was treated with a diagnosis: IHD. Stenocardia of tension. Postinfarction cardiosclerosis. During stress echocardiography, hypokinesia was detected in the A Base, IS Base, AS Base, A Mid, IS Mid, AS Mid segments. When calculating the K value according to the proposed formulas for the proximal part of the anterior interventricular artery K = +0.39, for the middle section K = -0.54, for the distal section K = -1. When carrying out coronary angiography, stenosis of the proximal part of the anterior interventricular artery was detected, which corresponds to the predicted data.
Example 2 . Patient B. Diagnosis: Anterior small-focal myocardial infarction, stress angina. When stress-echocardiography was carried out, hypokinesia was detected in the segments A Base, AL Base, AS Base, A Mid, AL Mid, AS Mid, A Apex. When calculating the value of K according to the proposed formulas for the proximal part of the anterior interventricular artery K = 0.68, for the middle section K = -0.21, for the distal part K = -0.52. When carrying out coronary angiography, stenosis of the proximal part of the anterior interventricular artery was detected, which corresponds to the predicted data.
CLAIM
Method for determining the localization of stenosis of the anterior interventricular artery of the heart, including pharmacological stress echocardiography and detection of anterior interventricular artery injury, characterized in that the lesion of the anterior interventricular artery is determined in three sections using the formula on the upper portion
K = 0.148 + 0.144X 1 + 0.129X 2 - 0.266X 3 + 0.24X 5 + 0.163X 7 + 0.24X 9 - 0.134 X 11 ,
In the middle
K = -0.49 - 0.202X 2 + 0.415X 4 - 0.405X 5 + 0.192X 6 + 0.287X 8 - 0.125X 9 - 0.206X 10 + 0.261X 11 + 0.063X 12 - 0.164 X 13 ,
Distal
K = -0.597 - 0.145X 1 + 0.084X 3 - 0.234X 5 + 0.15X 7 - 0.111X 9 + 0.083 X 10 + 0.14 X 11 + 0.212 X 12 + 0.091 X 14 ,
Where K is the prognostic coefficient;
X 1 - Asynergia in the A Base segment;
X 2 - Asynergia in the AL Base segment;
X 3 - Asynergia in the IL Base segment;
X 4 - Asynergia in the I Base segment;
X 5 - Asynergia in the IS Base segment;
X 6 - Asynergia in the AS Base segment;
X 7 - Asynergia in the A Mid segment;
X 8 - Asynergia in the AL Mid segment;
X 9 - Asynergia in the IL Mid segment;
X 10 - Asynergia in the segment I Mid;
X 11 - Asynergia in the IS Mid segment;
X 12 - Asynergia in the segment A Apex;
X 13 - Asynergia in the segment L Apex;
X 14 - Asynergia in the segment I Apex,
And the value of X for each of the considered segments is equal to +1 in the presence of asynergy and equal to -1 when it is absent and at a value of K> = 0, the presence of stenotic lesion of the considered section of the artery is predicted, and for K <0, no damage is predicted.
print version
Date of publication 05.04.2007gg
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