RU2221478C1 - Method for evaluating efficiency of treating patients with cardiovascular diseases - Google Patents

Abstract

FIELD: medicine, cardiology. SUBSTANCE: the present innovation deals with carrying out repeated samples with walking, calculating the power of loading, detecting parameters of hemodynamics and paces. The rate is gradually increased, by 1 km/h, not more; The duration of each loading mode corresponds to 3 min at intervals between them for the time to restore initial values of hemodynamics. One should calculate the ratio for the values of heart rate to that of frequency of paces and the value for "double product" gain being above a certain at the rate of 2 km/h to the value of corresponding gain of frequency of paces. Then one should establish the value of maximum rate, when both ratios do not quantitatively exceed 1, calculate the ratio for the value of "double product" gain being above initial to the value of relative power of loading/kg patient's body weight at established rate and therapy is considered to be efficient at higher value of established rate and decreased value of the last ratio. EFFECT: higher availability and accuracy of evaluation. 2 ex, 6 tbl

Description

 The invention relates to medicine, namely to cardiology, and can be used to evaluate the effectiveness of the treatment of patients with cardiovascular diseases (CVD).

 The reason for creating the invention is the lack of a simple and fairly accurate way of assessing the effectiveness of treatment of CVD patients with samples from walking (HR), which makes it difficult to control the adequacy of their drug therapy and non-medicated methods of treatment, including dosed physical activity (FN) on a bicycle ergometer, training walking and others

 Existing methods for assessing the effectiveness of treatment of patients with CVD are based, first of all, on determining the dynamics of physical performance (FRS) during exercise tests, such as bicycle ergometry and treadmillometry, which are carried out according to standard protocols. In addition, walking tests (HR) are used to determine hemodynamic parameters, maximum speed (or distance traveled in a fixed time), as well as load power, calculated by various formulas, and other parameters.

There is a method of evaluating the effectiveness of training in healthy untrained people and patients in the process of rehabilitation after illness through self-monitoring, which consists in determining the Fed during repeated tests with dosed walking on a horizontal surface (V.L. Karpman, Z. B. Belotserkovsky, I.A. .Gudkov. Testing in sports medicine. - M.: Physical education and sport, 1988. - 208 p.). For this purpose, power values are determined at two speed modes according to the formula: W = m • V • K, where W is the load power, W; m is the mass of a person in clothes and shoes; V is the speed of movement, m / s; K is the empirical coefficient, which is determined by the table proposed by the authors and quantitatively depends on the ratio of the stride length and the length of the test foot in shoes, as well as the length of the footprint in the shoes and the length of the feet. The Fed assessment is carried out by calculating PWC ₁₇₀ (Physical Working Capacity - translated from English) according to the formula: PWC ₁₇₀ = W ₁ + (W ₂ -W ₁ ) • (170-f ₁ ) / (f ₂ -f ₁ ), where PWC ₁₇₀ is the load power at which the heart rate rises to 170 in 1 min, W ₁ is the load power at the first speed mode, W ₂ is the load power at the second mode, f ₁ and f ₂ are the heart rate, respectively at the first and second preset speed modes.

The disadvantage of this method is that the Fed, which is a criterion for the effectiveness of training, is determined indirectly by extrapolating the results of two samples with walking. In order to increase the accuracy of calculating PWC _170, it is recommended that the heart rate (HR) for the first speed mode be 100-120 per minute, for the second - 145-160 per minute. However, achieving such a heart rate is often impossible in CVD patients because of their limited tolerance to FN or drug-induced bradycardia (for example, due to the use of β-blockers). At lower heart rates, its dynamics against a background of increasing FN is non-linear in nature, as a result of which PWC ₁₇₀ , calculated by the proposed formula, may be inaccurate. The above disadvantages limit the use of the known method for evaluating the effectiveness of training in the field of sports medicine.

 A known method for evaluating the effectiveness of treatment of patients with chronic heart failure (CHF) using a 6-minute HRP, widely used in the USA and other countries (Mareev V.Yu. Recommendations for the rational treatment of patients with heart failure. - Consilium medicum, volume 1, 3, 1999, pp. 109-146). The essence of the test is to measure the maximum distance that the patient travels for 6 minutes. Depending on the distance traveled by the patient, the degree of his physical activity is established and the corresponding functional class (fc) of heart failure is set according to the classification of the New York Association of Cardiology (NYHA) (disease of the heart and blood vessels: nomenclature and criteria for diagnosis. Ed. 6, Little-Brown, Boston, 1964): more than 550 m - physical activity is unlimited - I f.k .; 426-550 m - moderate restriction of physical activity - II f.k .; 150-425 m - a significant limitation of physical activity - III f. K., less than 150 m - a sharp restriction on the ability to perform any kind of FN - IV f.k. The walking test is recommended to be repeated in dynamics after treatment. Based on the results of repeated HRP, a conclusion is drawn on the effectiveness of the therapy.

 The disadvantage of this method of evaluating the effectiveness of treatment of cardiac patients is a unilateral interpretation of HRP only in physical terms: distance and time. The possibility of influencing the patient’s characterological qualities, his individual threshold of pain sensitivity and subjective tolerance of fatigue and shortness of breath is not taken into account. Some CVD patients do not adequately assess the severity of their condition, as a result of which they involuntarily choose excessive or, conversely, insufficient walking speed that does not correspond to their tolerance to FN, which may affect the value of the fixed distance. The known method does not include a mandatory assessment of the dynamics of indicators of blood circulation, which leads to a decrease in its clinical information content. In addition, the degree of physical activity and f. to. are established in a known manner fairly approximately, because are characterized by the distance traveled in 6 minutes with a significant difference between its minimum and maximum values (for example, taking into account the approximate interval of the distance covered, the speed value in some patients with chronic heart failure III FC may exceed that in others by almost 3 times).

 There is a method of assessing physical condition (as defined by the author) using 12-minute and 1.5-mile tests (Cooper K. The new aerobics. M. Evans & Co., New York, 1970), which are designed to select an aerobic training regimen and monitoring its effectiveness in healthy and patients with CVD. The 12-minute test involves overcoming by any means accessible by physical condition (walking or running) the maximum possible distance on level ground (without ascents and descents) in 12 minutes. The physical condition is established depending on the distance traveled, taking into account the age of the subject. The 1.5-mile test consists of running a distance of 1.5 miles in the shortest possible time. The gradations of the physical state are established depending on the time taken to cover the standard distance. Repeated tests are recommended to evaluate the effectiveness of aerobic training.

 The disadvantages of this method are the interpretation of test results only in terms of distance and time to overcome it, as well as the fact that the test is a healthy person or a patient who starts training and in the process, is carried out independently. A subjective assessment of the tolerance of the load, which guides the tested when choosing its intensity, determines the lack of accuracy and safety of the known method for assessing the effectiveness of training and physical condition in patients with CVD.

Closest to the achievement of the technical result is a (prototype) known method for evaluating the effectiveness of rehabilitation treatment by re-determining the Fed and the optimal training load when walking in patients with coronary heart disease (CHD) (Kutkin V.M., Nabiulin M.S., Dmitriev S. B. Method for the rehabilitation of patients with coronary heart disease (Patent for invention 2122826, 1998). Previously, a threshold load power is determined in a patient with coronary artery disease using bicycle ergometry. In order to establish the optimal training load, the usual walking speed is determined, its ergometric equivalent, expressed in watts, is calculated and evaluated, and the speed of movement, which determines 50% of the threshold power set during bicycle ergometry, is calculated. The load power (ergometric equivalent) when walking at the usual speed is calculated by the formula: N = αMυ $\genfrac{}{}{0ex}{}{\text{2}}{\text{wed}}$ / 2, where N is the load power, W; α is an empirical dimensional coefficient equal to 0.98 s ^-1 ; M - patient’s body weight, kg, υ _cf - uniform walking speed, m / s. The usual walking speed is used as a training if its ergometric equivalent does not exceed the threshold power. The speed necessary to maintain a load power of 50% of the threshold during training is determined by the formula: υ _cp = (2N / αM) ^1/2 . In the process of conducting HR, hemodynamic parameters are determined and the individual frequency of steps is calculated at the usual and calculated speed. The patient is guided by these values of CW during training by walking in the intermittent mode. At the end of rehabilitation treatment (including walking and drug therapy along with training), bicycle ergometry and HR are repeated, the effectiveness of treatment and rehabilitation measures is assessed by the dynamics of the threshold load power, the optimal training walking speed and the corresponding individual number of steps in 1 min.

 The disadvantage of this method of assessing the effectiveness of rehabilitation treatment of patients with coronary artery disease is the need for preliminary conducting a bicycle ergometry test to determine the threshold load, which reduces the availability of its use in practical medicine.

 A positive result of the invention is to increase the availability and accuracy of evaluating the effectiveness of treatment in patients with CVD by re-establishing the maximum value of speed when walking on a horizontal surface, at which optimal quantitative ratios of hemodynamic parameters to step frequency are observed, assessing the ratio of energy consumption to relative load power, as well as the value of the frequency of steps at the set maximum speed.

 The method is based on the following theoretical justification.

 While walking in a person, depending on the speed of movement, individual values of heart rate, blood pressure and blood pressure are determined, which are determined not only by his anthropometric data, but also by the state of health, as well as the effect of drugs. Quantitative changes in the values of hemodynamic parameters, step frequency, and their ratios under standardized high-speed walking modes have characteristic features in patients with various CVDs and reflect their Fed level.

 In patients with heart failure, for example, a decrease in the tolerance of FN is caused not only by stagnation of blood in the pulmonary circulation and large circulation, but also to a large extent by the limitation of muscle blood flow, structural and functional changes in skeletal muscle. Biochemical and structural rearrangement of skeletal muscles in this group of patients occurs along the path of increasing the number of white type muscle fibers, developing connective tissue, changing the density of the capillary network and abnormal changes in the metabolism of skeletal muscles. Increased muscle fatigue in heart failure is associated with early development of anaerobic glycolysis and intracellular phosphocreatinin deficiency after the onset of exercise. As a result of this, there is a violation of the frequency of locomotion, which manifests itself in standardized speed modes in comparison with the parameters of steps in healthy people.

 In patients with hypertension (GB), skeletal muscle is dominated by rapidly contracting (white) fibers (type 2 fibers). Unlike slow-contracting (red) muscle fibers (type 1 fibers), they contain 30% less capillaries per muscle fiber, as a result of which the vascular bed of the muscles is reduced, and the volume of blood flow is reduced. Hypertrophy of arterioles that feed muscle tissue also contributes to a decrease in blood flow. In “fast” fibers, the activity of oxidative enzymes is reduced, since they contain fewer mitochondria, and the activity of glycolytic enzymes and ATP-zy is very high. They are better suited to speed-power work, but they quickly tire. Remodeling and impaired functioning of the cardiovascular system, structural adjustment and changes in energy exchange in the peripheral muscles present in this category of patients are manifested by characteristic features of hemodynamic parameters and steps, as well as their relationships with standardized high-speed walking modes.

In order to determine the dynamics of the values of blood circulation indices, the frequency of steps and their quantitative relationships in HR, 222 healthy people of both sexes with normal body mass index, growth from 146 to 198 cm and 90 patients with CVD were examined. The age of individuals included in the study ranged from 20 to 60 years. During testing, the subjects were asked speed, starting from 2 km / h, with a stepwise increase of it by no more than 1 km / h. At the beginning of HRP, the usual speed of movement was determined. The duration of each load was 3 min with breaks between them for the time of restoration of the initial values of hemodynamic parameters. At the end of each load stage, heart rate and blood pressure were determined, respiratory rate (BHD) was calculated, and an electrocardiogram was recorded (using a Schiller mini-microscope (Switzerland) and an EK1K-01 electrocardiograph using a modified two-electrode lead). A “double product” was determined, equal to the product of systolic blood pressure and heart rate, divided by 100, in arbitrary units (cu). In the process of walking, an individual CH was recorded. The quantitative ratios of HR / NR and ΔDP _{2 km / h} / ΔЧШ _{2 km / h} were calculated, where ΔDP _{2 km / h} is the increase in the "double product" above that determined at a walking speed of 2 km / h, cu; NW _{2 km / h} - an increase in NW higher than defined at this speed. The choice of a speed of 2 km / h as a conditional starting point when calculating the increments in the DP and NW values is due to the following. When walking at a speed of less than 2 km / h, the energy expenditure of a person practically does not differ from their level during standing rest, as a result of which the ΔDP value, which reflects an increase in oxygen consumption and energy consumption, is not determined. At the same time, CW can reach 60 per minute. To estimate the quantitative ratio of the increase in energy expenditures to the corresponding increase in the frequency of locomotion “in the pure state”, it would be logical to use such a speed and the NW determined as the initial speed. However, it is practically impossible to accurately determine the upper limit of the "non-energy-intensive" speed and the corresponding step frequency. Therefore, as a compromise option of speed, its value equal to 2 km / h was adopted, at which the reproducible individual NR not much higher than the “non-energy-consuming” one is found in the subjects, and the DP is also slightly higher than the initial one, which allows using the DP values practically without loss of accuracy and BH, determined at 2 km / h, as the source when calculating the quantitative relations of the growth of these indicators.

During testing, the maximum walking speed was determined at which the values of both of the above quantitative relations did not exceed unity. A preliminary comparative analysis of these relationships in healthy people and patients with CVD (see below) gives reason to use values not exceeding unity to determine the level of optimal functioning of the cardiovascular system. The load power when walking with the set maximum speed was calculated by the formula: N = αMυ $\genfrac{}{}{0ex}{}{\text{2}}{\text{wed}}$ / 2. The relative load power in watts per kg of body weight was calculated by the formula: N = αυ $\genfrac{}{}{0ex}{}{\text{2}}{\text{wed}}$ / 2.
In healthy untrained men without burdened heredity in GB when walking at a speed of 2 km / h to the physiological limit, which is approximately 90% of the subjects, 8 km / h, the HR / N ratio decreases with increasing speed (see table 1), with speed of about 3 km / h becomes equal to unity, then with increasing speed reaches a minimum, after which it increases slightly, but does not exceed unity. The ratio Δ ДП _{2 km / h} / ΔЧШ _{2 km / h} does not reach this value either. In healthy, untrained women, the maximum walking speed is on average 7.5 km / h, and the quantitative changes in both relationships are practically the same as in men.

In endurance-trained people, the heart rate / HR ratio decreases to unity or less at a speed of no higher than 2 km / h. When the speed increases to its physiological limit when walking, the HR / N ratio is constantly less than unity and decreases (for example, for high-class runners, this ratio quantitatively approaches unity only when running at a fairly high speed), which is due to the initial bradycardia and a small increase in heart rate in Athletes under load. The value of the ratio Δ DP _{2 km / h} / Δ ЧШ _{2 km / h} in trained persons during walking is also significantly less than unity.

 In patients with neurocirculatory dystonia (NCD), who have a history of episodes of blood pressure increase above 140/90, but not presenting any complaints during the examination, when walking at a speed of 2 km / h to the limit, the ratio of heart rate to heart rate decreases to unity at a higher speed - about 4 km / h (see table 2), then decreases, but slightly, and begins to increase again up to the quantitative equality of unity and its excess.

The following regularity was revealed: the brighter the clinical symptoms of NDC and the higher the level of sympathicotonia, the lower the speed of movement, the final prevalence of heart rate over the heart rate is established, and the ratio ΔDP _{2 km / h} / ΔSCh _{2 km / h} exceeds unity. If the walking speed is above average (more than 6 km / h) in this category of patients, there is a tendency toward a reduction in NW. Of practical interest is the fact that similar changes in hemodynamics, NN and their ratios are found in practically healthy people with burdened heredity for GB.

 In 17 patients with heart failure of various etiologies, Ш-IV f.k. according to NYHA classification, the maximum walking speed (2.6 ± 0.02 km / h), established taking into account the quantitative ratios of blood circulation to HF, as well as the level of energy consumption and frequency response of walking, had significant differences from those found in healthy people and CVD patients without cardiac insufficiency.

 An increase in heart rate in patients with heart failure with increased physical activity by walking is more pronounced and an increase in heart rate / heart rate to unity occurs at a lower speed. In this category of patients, a significant increase in HH was revealed when comparing it with the pace of steps in healthy people with the same anthropometric data at the same speed (for example, at a speed of 2 km / h, the HH in patients was 77.3 ± 2.4 versus 65.0 ± 1 , 7 per minute - in healthy people) (p <0.05). In our opinion, an increase in HF is of a compensatory nature, since it allows to some extent minimize the ratio of heart rate and HF in this group of patients.

In 32 patients with hypertension (22 men and 10 women) who underwent the study (in accordance with the classification of DAG ₁ - these are patients with arterial hypertension of 1-2 degrees, with a risk of 1-3), the reduction in heart rate / HR ratio to unity, so same as in patients with neurocirculatory dystonia, was observed on average at a speed of about 4 km / h (see table 3).

At a speed of 4.8 to 6.7 km / h, averaging 5.6 ± 0.3 km / h, most patients included in the examination experienced dizziness, headache, and other symptoms of exercise intolerance. The initial blood pressure and its increase in this group of patients when walking was significantly higher in comparison with healthy untrained people and patients with NDC (p <0.05). Of the 32 patients, eight took antihypertensive drugs regularly (enalapril, hypothiazide, arifon, corinfar retard, and other drugs), 20 people - only with increased blood pressure (clonidine, capoten, corinfar, etc. drugs) and 4 people did not take anything. The subjects showed a tendency to decrease HH compared with healthy individuals of the same height at the same walking speed (for example, at a speed of 5 and 6 km / h, the HH in patients with GB was 106.4 ± 2.1 and 114.9 ± 2, respectively, 3 per minute, in healthy - 112.2 ± 2.0 and 123.0 ± 3.1 per minute). In all cases, the onset of symptoms of FN intolerance in patients with GB was preceded by a quantitative increase of not less than a unit of ratios Δ DP of _{2 km / h} / Δ NP _{2 km / h} and HR / HR.

 It should be noted that other types of locomotor-hemodynamic relationships can be detected in patients with hypertension, however, the proposed method for interpreting the results of HRP is also valid for them.

In 16 patients with coronary artery disease with exertional angina and post-infarction cardiosclerosis (in 8 patients out of 16 examined myocardial infarction preceded by GB), including in 12 patients with bradycardia due to the use of β-adrenergic blockers (as a result, the orientation to the HR ratio becomes impossible during the test / NR), a quantitative increase in the ratio ΔDP of _{2 km / h} / ΔNR of _{2 km / h} to unity was observed at a speed preceding that which causes the appearance of anginal pain (see table 4). This circumstance is especially important, since it allows you to timely limit the speed of movement during PX and, thus, ensure the safety of its conduct in this group of patients. It should be noted that out of 16 patients with coronary heart disease, with a speed increase above 5 km / h, 12 people continued testing with a walk, with an increase above 6 km / h - 6 people. The latter stopped walking at 7 km / h on average after 1.5 minutes due to the appearance of fatigue, in 2 patients a slight dizziness appeared. Taking into account the body weight of each patient and the established maximum speed, the maximum load values were calculated: in 4 patients it averaged about 70 W, in 6 patients - 102 W and in 6 patients - 123 W (in the latter - adjusted for the time of the load), which approximately corresponded to the maximum tolerated load established in this group of patients with bicycle ergometry. Comparing the NW at a walking speed of 4 km / h in this group of patients with rehabilitation at the sanatorium stage (after 30-35 days from the onset of myocardial infarction), we can note its tendency to decrease: from 109.2 ± 2.6 per minute to 100 , 0 ± 2.9 per minute.

As can be seen from the above data, patients with CVD have a significant increase in energy expenditure when the relative load power is the same with healthy people, as evidenced by a significant increase in their ratio ΔDP / N _rel (proposed by Zamotaev I.P. et al. In 1978 under the name "cardiac load index" for assessing energy costs in patients with hypertension with bicycle ergometry) (p <0.05).

According to our data, the positive clinical effect of treatment in CVD patients in all cases is accompanied by an increase in the maximum walking speed, at which the quantitative ratios of heart rate / NW and Δ DP of _{2 km / h} / Δ NP _{2 km / h} do not exceed unity, and a decrease in the ratio Δ DP / N _rel . Adequate therapy and physical training in the optimal mode lead to the approximation of the values of these relations, and in some cases, the values of N, to those of healthy people.

 Taking into account the quantitative relations of hemodynamic indices to BH allows one to increase the objectivity of evaluating the effectiveness of treatment, since the maximum speed established by their values reflects the limits of the optimal functioning of the cardiovascular system under natural, closest to everyday physical exertion. In addition, the exact establishment of the maximum value of walking speed (and load power), which does not cause pathological functional changes in the circulatory system, makes it possible to ensure the proper level of safety for testing patients.

Examples of clinical applications for evaluating the effectiveness of treatment in CVD patients by conducting HR on a horizontal surface:
Example 1
Patient I., 25 years old. Height is 1.65 m, body weight 59.5 kg. Diagnosis: NDC according to the hypertonic type. Complaints of increasing blood pressure to 140-150 / 95 mm Hg, heart rate from heart rate to 100-115 per minute and stitching pains in the heart. Examined by an endocrinologist: no pathology from the thyroid gland was found. From the age of 50, the patient’s mother was diagnosed with GB. Performed HR: initial indicators: HELL 140/84 mm Hg, heart rate 88 per minute, NPV 17 per minute. At a maximum walking speed of 6 km / h, ChSh 116 per minute, HELL 160/94 mm Hg, heart rate 114 per minute, NPV 32 per minute. The HR / NR and ΔDP ratios of _{2 km / h} / ΔNR of _{2 km / h are} quantitatively close to unity and amounted to 0.98 each, and the ratio ΔDP / N _rel - 0.75 cu At a speed of 6.5 km / h in the 2nd minute, symptoms of fatigue, shortness of breath and slight dizziness appeared. When bicycle ergometry, the maximum tolerated load in the patient was 85 W (the execution time of the last stage of the load, equal to 90 W, was 2.5 minutes). The test is terminated due to dizziness. HELL at a load height of 186/90 mm RT. Art. , Heart rate - 156 per minute, NPV - 36 per minute. For comparison: the load power corresponding to the set maximum speed when walking was approximately 81 watts.

For 2 weeks, the patient took anaprilin 20 mg 2 times a day and sedatives as prescribed by the cardiologist. Her health improved, a decrease in blood pressure and heart rate was noted, however, the patient began to periodically note apathy and worsening mood. The repeated HRP was performed: initial data: blood pressure 122/80 mm Hg, heart rate 68 per minute. The maximum speed was 7.5 km / h, at which the speed reached 150 per minute, blood pressure 152/86 mm Hg, heart rate 104 per minute, and NPV 28 per minute. The quantitative ratio of heart rate / ChS was 0.69, ΔDP _{2 km / h} / ΔCH _{2 km / h} - 0.99 o. e., and the ratio ΔDP / N _rel - 0.59 cu The test was discontinued due to the patient's inability to increase the speed of movement. With repeated bicycle ergometry, the maximum transferred load power was 120 watts. The maximum load power, calculated according to the results of PX, is approximately equal to 126 watts.

 In this case, the positive effect of treating a patient with a non-selective, lipophilic β-adrenergic blocker - anaprilin - was expressed in an increase in maximum speed, normalization of blood pressure and heart rate at rest and a decrease in their growth in patients with heart failure, as well as in the appearance of energy saving when walking (given the patient’s signs of depression , anaprilin was later replaced by atenolol at a dose of 25 mg 2 times).

 When comparing with the prototype, fairly close values of the maximum tolerated load were established during repeated HRP and bicycle ergometry. Thus, the proposed method for evaluating the effectiveness of treatment, not claiming the quantitative accuracy of determining the Fed, objectively reflects in the dynamics of its changes in the treatment process.

Example 2
Patient G., 48 years old. Height 1.62 m, body weight 55 kg. Diagnosis at admission to the hospital: Rheumatism, inactive phase. Mitral stenosis. Condition after commissurotomy (1978). Restenosis Atrial fibrillation, persistent tachysystolic form. III-IV f.k. NYHA classification. Complaints of shortness of breath and palpitations with a slight load, rapid fatigue. Takes digoxin 1/2 tablet. 2-3 times a day (irregularly), furosemide 2 times a week for 1 table. in the morning, periodically, panangin, as well as enalapril 2.5 mg 2 times a day (during the last year, the treatment is adjusted independently). Bicycle ergometry was not performed due to the severity of the patient's condition. In addition, the patient does not have cycling skills.

 Conducted HR: see table 5.

The test was discontinued due to pronounced fatigue and shortness of breath. As can be seen from the data, the patient already at a speed of 3 km / h, the ratio Δ DP _{2 km / h} / Δ ЧШ _{2 km / h} reached 1.17. e. Heart rate / ChS is constantly greater than unity (despite the patient’s significant increase in ChS). From the results of HRP, it follows that the patient does not tolerate any, even insignificant, load. According to the degree of possible physical activity, she can set IV fc NYHA classification.

 3 weeks after the therapy (digoxin 2 tablets per day, a polarizing iv mixture drip with the introduction of lasix at the end, veroshpiron 1 tablet per day, furesis 0.04 3 times a week in the morning), repeated HR was performed (see Table 6).

Symptoms of FN intolerance: fatigue and shortness of breath occurred in a patient while walking at a speed of 3.5 km / h after 1.5 minutes. The ratios HR / NR and ΔDP of _{2 km / h} / ΔNR of _{2 km / h} exceeded the value equal to unity. In this case, the positive effect of treatment was reflected in the emergence of the opportunity for patient walking at a speed of up to 3 km / h, at which there are optimal locomotor-hemodynamic ratios.

 For comparison with the prototype: evaluating the effectiveness of treatment by determining the Fed in a known manner in a patient is impossible.

 The above examples show sufficient simplicity and accessibility, as well as the accuracy of the proposed method for evaluating the effectiveness of treatment in patients with CVD.

 A positive result of the invention is to increase the availability and accuracy of evaluating the effectiveness of treatment of cardiological patients with HR, which is achieved by the integrated use of individual indicators of blood circulation and step parameters, establishing the maximum speed at which their optimal relationships are observed, as well as the possibility of this testing method practically in any medical institution, as this does not require additional equipment.

 Using the proposed method for evaluating the effectiveness of treatment of patients with CVD by re-establishing the maximum walking speed at which the optimal quantitative ratios of hemodynamic parameters to NW values are observed, and determining the dynamics of energy levels, it was possible to improve the treatment results of patients with NDC, GB, CHD and CHF of various etiologies in the therapeutic departments of the hospital and clinic.

Thus, the claimed technical solution has higher efficiency compared to the prototype, since:
- allows you to objectively assess the effectiveness of treatment, as well as conduct its adequate correction in patients with various CVDs,
- makes it possible to control the change in the Fed in patients during treatment,
- provides a sufficient level of security for testing,
- is physiological and affordable, since it does not require special skills in the patient and complex expensive equipment.

 The method is simple to implement and can be used in hospitals, clinics, resorts and other medical institutions.

Claims (1)

A method for evaluating the effectiveness of treatment of patients with cardiovascular diseases by conducting repeated tests with walking, calculating the load power, determining hemodynamic parameters and steps, characterized in that they set the speed with a step-like increase of it, by no more than 1 km / h, with a duration of execution each load regime for 3 min and breaks between them for the time of restoration of the initial hemodynamic parameters, and the ratio of the heart rate to the value of the step frequency is calculated and In other words, the increment of the “double product” is higher than that determined at a speed of 2 km / h to the value of the corresponding increment in the frequency of steps, the maximum speed is set at which both ratios do not quantitatively exceed unity; per 1 kg of patient’s body weight at a set speed, and treatment is considered effective when the value of the set speed increases and the last ratio decreases.

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