section Home
Production, Amateur
Radio amateur
Model aircraft, rocket-
Useful, entertaining 		Stealth master
Electronics
Physics
Technologies
invention 		space Mystery
Earth Mysteries
Secrets of the Ocean
Stealth
section Map
Start
Forum
Use of material is permitted for reference (for websites - hyperlinks)
INVENTION
Russian Federation Patent RU2233613

METHOD predicting the outcomes of myocardial infarction

METHOD predicting the outcomes of myocardial infarction

Name of the inventor: Alekseeva OP (RU); Novichikhina IA
The name of the patentee: Military Medical Institute of the Russian Federal Border Service at the Nizhny Novgorod State Medical Academy
Address for correspondence: 603001, Nizhny Novgorod, Nizhny-Volzhskaya Naberezhnaya, 1/1, IUI FSB Russia, NIRIO.
Starting date of the patent: 2002.03.26

The invention relates to medicine, cardiology. In the first days of myocardial infarction determines the type of hemodynamics. Identify the degree of left ventricular diastolic dysfunction. , Serum and saliva. Calculate the partition coefficient of creatine. With the combination of hyperkinetic or hypokinetic type of hemodynamics, diastolic dysfunction of the left ventricle above the 2 nd degree of creatine and distribution coefficient below 2.6 predict adverse outcome of myocardial infarction. The method allows a comprehensive and in early to assess the need for cardiac surgery.

DESCRIPTION OF THE INVENTION

The proposed method relates to medicine, in particular to cardiology, and is designed to predict an adverse outcome of myocardial infarction in the early hours of admission to hospital, and a decision on the future conduct of a patient in cardiac surgery department.

Hospital mortality of patients with acute myocardial infarction (MI) is up 27%, and in cardiogenic shock up to 90%. Timely surgical intervention can increase the survival rate of 75 to 96% (J.Hocman, T.Jemtel, 1994; E.Grech, 1994). The time factor plays a big role, so predicting the course and outcome of diseases, in the first day the patient receives adequate treatment in a timely manner.

The definition in the early stages of the patient's lack of functional reserve of the left ventricle is sufficiently accurate method of predicting adverse outcome in patients with myocardial infarction [3].

The process is as follows: studies carried out on LFOV-IV gamma camera (US), combined with the computer PDP 11/34-a (US). The detector gamma camera is used with a parallel collimator for low energy radiation. The energy discriminator gamma camera is set to a gamma radiation fotonnik used nuclide (99m Tc - 140 keV energy window with width - 15%). Research carried out on the functional bed with the patient lying on his back. The detector gamma camera positioned over the heart area in the left anterior oblique (30-45 °) with an additional projection bias (10 °) to the side of the head for better visualization of the left ventricle of the heart. After intravenous administration of a dose indicator (275-300 MBI) Tc 99m -pertehletata spend cardiosynchronized scintillation registration information at the first passage of a bolus of radioactivity through the left ventricular cavity. According to radiometric measurement is carried out in stroke volume and left ventricular ejection maximum speed. Carry out the test with a load capacity carried out by raising to 45 ° straightened lower limbs of the patient. During the tests carried out the re-introduction of the indicator dose Tc 99m - pertehletata and according to the radiometer measures the stroke volume of the left ventricle and a top speed of expulsion during the reaction to the amount of the load. Determine the ratio of the formula Cp. Decrease Kf is less than 6.5 indicates a left ventricular functional reserve exhaustion and poor outcome - myocardial infarction.

The known method is accurate because it gives full details of the contractility of the heart with minimal exertion during the acute phase of myocardial infarction.

However, this method is technically difficult to perform research requires not only expensive equipment but also training of qualified personnel. Implementation of these studies require a special hospital radiological laboratory, conditions for transportation and storage space radioisotope. In addition, exploring the backup function of the heart, does not give a comprehensive assessment of other compensatory mechanisms of the organism.

Yabluchansky and Soave. [11] by examining blood cells, during the first day offers to predict the outcome of myocardial infarction by the ratio of the number of granulocytes among agranulocytes. The method is simple, fast and perform accurately reflects the state of adaptive reserves of the organism. However, concomitant diseases can significantly affect the blood picture, distorting the accuracy of the result.

The purpose of the proposed method is the ease and speed of implementation, acceptability for the patient and staff, precise evaluation of not only the function of the heart, but also the body's ability to adapt its capabilities to the conditions of circulatory hypoxia. The object is achieved by the proposed method, including a comprehensive assessment of the body: the analysis of a biological object, such as an assessment of central hemodynamics and assessment of left ventricular diastolic dysfunction.

In determining the biochemical parameters of blood and saliva, we increase the accuracy of forecasting methods used tools. As a biological object is taken the blood-work salivarnogo barrier. To determine the ratio of the amount of creatine in the blood and saliva. Creatine determine the diacetyl method. Then, identify the type of hemodynamics using integral rheography of the body. Measuring parameters of transmitral flow by echocardiography, establish the degree of left ventricular diastolic dysfunction. The combination of hyperkinetic or hypokinetic type of hemodynamics with diastolic dysfunction of the left ventricle above the 2 nd degree of creatine and distribution coefficient below 2.6 is a predictor of unfavorable outcome MI determined in the first day of the disease.

Selecting salivarnogo blood-barrier (GCR) as an indicator of the work dictated by proving the contribution of GSB in the homeostasis of the internal environment of acute forms of coronary heart disease (CHD). Proved particularly active and permeability of the GSS on the severity of the pathological process and features of myocardial infarction flow [1]. Creatine is a substance taken without exogenously korregiruemoe and at the same time strongly reflecting energy processes occurring intracellularly. Violation of diaphragm pumps the active transport of creatine into the cell is an early sign of depletion of energy resources of the myocardium, leading to heart failure [2].

Integral indicator of cardiac hemodynamics, determining its type, is reserve ratio (CR). In healthy people, the CD value is stable and amounts to 1,0 ± 0,1. According to the calculated ratio of provision, stroke index, systolic blood pressure, you can set the type of central hemodynamics. The nature of intracardiac flow changes with the appearance of myocardial ischemia [4]. The increase in pressure in the left atrium (LA), the reduction of isovolumic relaxation time (IVRT) is accompanied by restrictive physiology of left ventricular diastolic filling (LV) and is a poor prognostic sign, as evidenced by a variety of studies [5, 6, 7].

In our research it has been proved by Bayes, that the combination of features described above in the first days of myocardial infarction suggest an unfavorable outcome of the disease.

The proposed method is carried out as follows: patients with acute myocardial infarction, after a preliminary rinsing of the mouth cavity with a solution of distilled water, saliva was collected, centrifuged and the supernatant analyzed. Simultaneously carried vennoy blood sampling, then poured into 0.3 ml of 3.8% sodium citrate in a tube is added to 3 ml of blood. Centrifuged for 10 min at 3000 rev / min. The supernatant was removed, washed with 4 ml of red blood cells with a solution of 0.9% NaCl, centrifuged for 10 minutes more. Washed 2 more times erythrocytes. Then take 0.1 ml of washed erythrocytes was added 0.4 ml of distilled water and 1.5 ml of 10% trichloroacetic acid. After 5 min, the erythrocytes are ready for analysis. The principle of the method is that creatine protein-free filtrate of red blood cells and in the presence of saliva parahlormerkuribenzoata solution, an alkaline solution and a naphthol diacetyl solution gives color, whose intensity evaluated calorimetrically at a red light filter (540 nm) versus control, which take water instead of the object , the calculation is carried out according to the formula.

where C - the concentration of creatine, mol / L;

E op - extinction of the test solution;

0.0763 - the number of mol of creatine in 1 ml of standard solution;

E st - extinction standard.

Then calculate the partition coefficient of creatine (KRkr), dividing the concentration of creatine in the blood concentration of creatine in the saliva.

To evaluate the diastolic left ventricular dysfunction (DDLZH) using four standard access. Apply a pulse-wave Doppler method, and set the control volume is equal to 2-4 mm. Score is determined by the background of quiet breathing in the expiratory phase analysis taking the average value of three measurements of cardiac cycles. From the apical access is obtained 4-chamber heart image and explore the diastolic filling of the left ventricle and the blood flow in the right superior pulmonary vein. On the spectrum of transmitral blood flow estimate of LV diastolic filling structure-E / A (E - rate of left ventricular early diastolic filling, A - the maximum speed in the late diastolic filling) and slow and the time of rapid filling flow - DT. In accordance with the objectives of the study calculated a set of parameters of blood flow in the pulmonary veins: peak systolic velocity - S and diastolic - D antegrade wave peak velocity diastolic retrograde waves - Z, the ratio S / D.

Time isovolumic relaxation LV IVRT determine when simultaneous access location of the apical systolic flow in the LV outflow tract and diastolic transmitral flow as the interval between the end of the first and beginning of the second stream. Degree DDLZH evaluated in accordance with the Canadian classification presented in Table 1 [8].

Hemodynamic performance is determined by M.I.Tischenko [10], on KSVG device - 1T. To record IrGTU two electrodes connected together to reinforce the upper and lower extremities. Are used to stabilize the resistance between the skin and electrode pads soaked with an alkaline solution. A study carried out lying. IrSTU recorded with an amplitude of 20-25 mm, which is compared with the amplitude of the calibration signal corresponding to a change in circuit resistance of 0.1 ohms. Measurement is carried out by the base resistance balancing calibrated scale with an accuracy of ± 1,5 ohms. Calculate the stroke and minute volume of blood circulation and their specific values ​​- stroke and cardiac indices (SI, SI). Due to the fact that depends UOLZH respiration phases determined average values ​​of elements curve and calculate the average value of a typical breathing cycle. In the presence of atrial fibrillation or frequent extrasystoles average value determined for 15-20 minutes. Body surface is determined according to the equation Du Bois nomogram Todorova. Within the normal range sigmalnogo values ​​are shown below. reserve ratio (CR) as the ratio of the actual minute volume to a proper volume of physiological blood flow conditions for peace. Due to the conditions of the IOC physiological rest is calculated by multiplying the IOC due to the conditions of basal metabolism by a factor of 1.35. Due to the IOC basal metabolism is calculated by N.N.Savitskomu [9] by dividing the proper basal metabolic rate, determined by the table of Harris-Benedict and Kirsten-Knipping, to the number 422, which is a product of the mean colorimetric ratio of oxygen to the normal arterio-venous difference O for 2 minutes, and the number per day. In normal people reserve ratio stable at 1,0 ± 0,1 [10].

The proposed method to 90 people were surveyed in the first days of myocardial infarction. Patients were observed during the entire hospital and 3 months after discharge from hospital. 63% of patients had a favorable outcome.

Basic calculations for estimating the accuracy of the proposed method for predicting adverse outcome were carried out on the basis of known mathematical modeling methods for pattern recognition.

Used Wald sequential analysis using Bayes' formula proved the sensitivity and specificity of selected criteria such as features that define images. Serial analysis provides the same and a value b, and that the usual methods (S.Glants, 1999 YG) [12].

In this case, the Bayesian formula takes the following form:

This result, at the critical a = 0,05 and b = 0,05, more than 19, and therefore one could argue that the combination of features X 1, X 2, X 3 31 times higher likelihood of an unfavorable outcome.

Clinical examples of the use of the proposed method

example 1

Extract from history №3049.

Karasev Alexandra, '74, entered MLPU №33 25.03.01. diagnosed with acute anterior-lateral non-Q myocardial infarction, Killip III. The history of coronary heart disease more than 20 years, exertional angina 3 clinical and functional class (CFC), 1 myocardial infarction, transient ischemic attack once, chronic heart failure to myocardial infarction CK II (for NYHA). Objectively, weakness, dyspnea, skin pale, akrotsianoz, severe dry mouth. Respiratory rate (RR) 25 1 min, a large number of auscultation moist rales, heart rate (HR) 96 1 min, blood pressure (BP) 170/105 mm Hg. Art. When instrumental research in the early hours of admission to MLPU identified: hyperkinetic hemodynamic type (KR - 1.5, systolic blood pressure (SBP) - 170 mmHg, MI - 28 ml / m 2..). On echocardiography (echocardiography): Marked reduction in global left ventricular contractility, asymmetric hypertrophy of the interventricular septum, dyskinetic movements apex-anterior-segment of the wall (chronic aneurysm). According doplerkardiogramme: tricuspid regurgitation grade 2, the symptoms of pulmonary hypertension, 4 degree of left ventricular diastolic dysfunction: transmitral flow pseudonormal Type (E / A> 1), antegrade diastolic flow (S / D <1,0) predominates in pulmonary spectrum. In the blood, 445 mmol / l, in the saliva 337 mmol / l = 1.3 KRkr. All indicators point to the unfavorable outcome of myocardial infarction. In the subacute stage patients worried frequent chest pain, for the period of hospital observation with cardiac insufficiency II CK reached III-IV CK, physical activity is severely restricted.

example 2

Extract from history №5306

Fomicheva Seraphim Semenovna, '82, entered MLPU №33 25.05.01. with a diagnosis of acute anterior (high) Q myocardial infarction, Killip II. In history there is no heart attacks, angina of effort over the past 5 years, 2 CK, chronic heart failure to myocardial infarction CK II (for NYHA). Objectively, weakness, dyspnea, skin pale, akrotsianoz, dry mouth. RR 24 in 1 min, auscultation breath harsh in light weight wheezes, single wet only in the lower lungs. HR 72 in 1 minute, blood pressure 150/80 mm Hg. Art. When the instrumental study found: hemodynamic eudinamichesky type (KR - 0.91, GARDEN - 150 mmHg, MI - 39 ml / m 2..). On echocardiography: moderately reduced global contractility of the left ventricle, moderate hypertrophy of the basal parts of the interventricular septum, 1-2 degree of diastolic left ventricular dysfunction: abnormal transmitral flow type (E / A <1), the spectrum is dominated by pulmonary systolic antegrade flow (S / D> 1.0). In the blood, 427 mmol / l, in the saliva 207 mmol / l = 2.1 KRkr. The patient was observed early rehabilitation stage of heart failure in hospital observation period remained at the same level.

INFORMATION SOURCES

1. Alekseeva OP Clinical and biological aspects of the function of the blood-salivarnogo barrier in acute forms of coronary heart disease .// Diss ... dokt.med.nauk, Nizhny Novgorod, 1992

2. Pereslegina IA Contractility of the myocardium, and energy exchange in experimental aortic stenosis and after surgical correction. // Diss ... Candidate of medical sciences. Volgograd 1979

3. Bobrov VA, IE Malinovskaya, VA Shumakov, Titkov IB The process flow forecasting hospital myocardial infarction period .// A. p. №2078535 C1, RF, A MKI 61 5/02, 8/06, 1997.

4. Liu Sha., Yang Oing., Li Yueping. Evaluation of diastolic left ventricular function in patients with myocardial infarction // Henan yike daxue xuebao // VINITI Library; 1999, №2, 69-71.

5. Weihs W. Dopplerechokardiographische Beurteilung der diastolischen linksventrikularen Funktion bei Koronarer Herzkrankheit // Deutch. Med. Welt, 1998, September.

6. Pennok GD, Yun DD, Agrawal PO, Echocardiographic changes after myocardial infarction in a model of left ventricular diastolic dysfunction // Am. J.Physiol: Heart and Cric Physiol; 1997, №4: p.2018-2029.

7. Garcia-Rubiera JC, Garcia-Martinez JT, Hidalgo R, Gomez-Barrado JJ, et al Doppler transmitral flow pattern is an independent prognostic factor in acute myocardial infarction. // Cardiology; 1997, 88 (2): p.203-6.

8. Rakovsky H, Appleton C, Chan K, et. al. Canadian consensus recomendation for the measurment and reporting of diastolic disfunction in echocrdiography // J.Am.Soc.Echocardiography; 1996, №9: 736-60

9. Savitsky NN Biophysical basics of blood circulation and clinical methods for studying the hemodynamics. // L. 1974.

10. Tishchenko, MI Measurement of stroke volume by the integrated rheogram body // Physiological Journal of the USSR; 1973; 59 (8): 1261-1224.

11. Yabluchansky NI Pilipenko VV, Shevchenko VI, Tsarbaev BA A method of predicting the outcome of myocardial infarction. // AS №10665445 A USSR, MKI A 61 10/00 1984.

12. Glantz S. Biomedical Statistics .// Moscow, Practice, 1999; 189.

CLAIM

A method of predicting the outcome of myocardial infarction by studying the function gematosalivarnogo barrier, central and intracardiac hemodynamics, characterized in that the first day of the disease determine the type of hemodynamics, diastolic dysfunction of the left ventricle and the partition coefficient of creatine, and the combination of hyperkinetic type or hypokinetic type of hemodynamics, diastolic dysfunction of the left ventricle above the 2 nd degree of creatine and distribution coefficient below 2.6 predict adverse outcome of myocardial infarction.

print version
Publication date 05.04.2007gg