RU2258458C2 - Method for predicting severity degree of autonomic dystonia syndrome - Google Patents

Abstract

FIELD: medicine, cardiology.

SUBSTANCE: one should register a rhythmocardiogram, detect spectral values for variability of cardiac rhythm, calculate the value of autonomic index, calculate the value of autonomic tonicity by the following formula: AI/lnTp m sq. sec., where AI - autonomic index, lnTp - total power for the spectrum of variability of cardiac rhythm. At values above 3.1 one should diagnose severe flow of autonomic dystonia syndrome, at values being 3.1-2.2 - moderate flow of the mentioned disease, at values ranged 2.1-1.5 - light flow. The method enables to predict the development of hemodynamic disorders.

EFFECT: higher efficiency and accuracy of diagnostics.

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Description

The invention relates to medicine, namely to cardiology, and can be used in the diagnosis of the severity of autonomic dystonia syndrome.

The relevance of the study of the functional pathology of the heart, the main manifestation of which is autonomic disorders, is primarily due to the high incidence, reduced quality of life and the need for differential diagnosis of this pathology with a number of other diseases (1). Since puberty, the incidence of autonomic disorders is 25 - 80% (2, 3). According to the results of a large epidemiological study carried out by employees of the Department for the Study of Border Mental Pathology and Psychosomatic Disorders of the NCHP RAMS, autonomic dystonia syndrome (cardioneurosis) occurs in 4.7% of patients of the general medical network of different ages (4). A feature of autonomic pathology is that it acts as an independent disease quite rarely and, as a rule, is secondary in nature. However, in young people, autonomic disorders acquire leading significance, and in older people they are presented in an objective picture of somatic disease (4). The complexity of all methods of diagnosing autonomic dystonia syndrome (SVD) is determined by the lack of clear objective criteria between the norm and the beginning pathological changes in the cardiovascular system (5, 6, 7).

According to modern concepts, in many patients with SIDS, existing functional disorders of the cardiovascular system (CVS) can be a pre-stage of such organic diseases as coronary heart disease, hypertension, etc. (1, 8, 9, 10). In this regard, it becomes obvious that for more careful observation and treatment, it is necessary to identify patients with SIDS who have a predisposition and an increased risk of developing these cardiovascular diseases.

In modern medicine, to verify clinically significant changes in CVS, the latest highly accurate instrumental diagnostic methods are used, such as Holter monitoring of the electrocardiogram and blood pressure, echocardiography with dopplerography, and electrocardiography (ECG). However, in most patients with borderline pathology, the use of these methods is uninformative and can be diagnosed only after functional stress tests (bicycle ergometry, pharmacological, physical tests, etc.) (5, 6, 7).

A known method for diagnosing the symptoms of autonomic dystonia syndrome using the "Questionnaire for identifying signs of autonomic changes", which is filled in by the examined patient (5). Each symptom corresponds to a certain number of points, which depends on the significance of the clinical manifestations affecting the adaptive capabilities. After mathematical processing of the results, the total score for healthy individuals should not exceed 15, in case of excess it is necessary to talk about the presence of SVD. This method is used for mass examinations, often at the outpatient stage, is simple and quick to perform. It allows you to evaluate the general vegetative tone, which is composed of existing autonomic disorders from a particular system (5). This method helps to detect the presence of SVD both in patients presenting complaints and in those without them. The latter can serve as a risk factor, which should be taken into account during preventive examinations.

The obvious drawback of this method is the subjective assessment of the patient’s own condition, which raises doubts about its accuracy. In addition, it does not allow to fully evaluate the direction of systemic autonomic manifestations from the cardiovascular system, does not make it possible to judge the functional state of the circulatory system, determine the severity and, accordingly, correctly prescribe treatment.

A known method of studying vegetative status, developed by A.D. Soloviev (1981, 1998) (5). It combines the history, subjective symptoms, the results of objective studies (ECG, arterial systolic and diastolic blood pressure, the number of heart contractions, minute volume of blood) and vegetative status in a single table. Subsequently, after calculating the total number of points characteristic of each characteristic obtained, all the material collected is subjected to mathematical processing on a computer. When analyzing the table, special attention is paid to integrative indicators (for example, blood pressure, minute volume, etc.), which give an idea of vegetative changes within the system, and the sum of indicators in different systems allows you to more fully judge the initial vegetative tone of the body (5) .

This method is not accurate enough, because when assessing the autonomic tone in the cardiovascular system by carefully analyzing subjective, objective symptoms, instrumental data, including an ECG, it is not possible to determine the severity of autonomic disorders with a high degree of accuracy (11).

As a prototype, a method for diagnosing SVD using spectral HRV indicators - VLf, Lf, Hf, balance coefficient of sympathetic and parasympathetic activity Lf / Hf, calculated during daily ECG monitoring (9) was taken. This method notes changes in the studied parameters in SVD, aimed at identifying the nature of the course (paroxysmal or permanent). In the paroxysmal course of SVD, predominant sympathetic influences on the heart rhythm are observed, a decrease in spectral characteristics at all frequencies of the spectrum is observed VLf = 1521 ± 225, Lf = 207 ± 246, Hf = 648 ± 177, an increase in the ratio Lf / Hf = 2.0 ± 0.4. The permanent variant of the course is characterized by the predominance of parasympathetic influences VLf = 2413 ± 227, Lf = 1659 ± 270, Hf = 1521 ± 522, Lf / Hf = 2.0 ± 0.5 (9).

However, this method is not without drawbacks, the main of which is a decrease in accuracy due to the duration of the observation (24 hours), during which a vegetative crisis (sympathoadrenal, vago-vasal) may not occur. Due to the presence of many factors unaccounted for by the researcher that affect the heart rate variability, the accuracy of the results obtained and, accordingly, their interpretation are reduced. The method does not allow to identify the severity of SVD and, accordingly, to conduct the correct treatment.

To increase the accuracy of diagnosis of autonomic dystonia syndrome, by identifying its severity, a vegetative index (Kerdo) is calculated, spectral indicators of heart rate variability (Hf, Lf, VLf, Hfn, Lfn, Tp) are determined and an indicator of vegetative tone in the cardiovascular system is calculated , which is the ratio of the value of the vegetative index (VI) to the indicator of the total power of the spectrum (Tp (ms ² )), the severity is estimated by its values.

The method is as follows:

After a general clinical study, including the measurement of systolic and diastolic blood pressure, counting the number of cardiac contractions at rest taking into account age-related changes (6), the symptoms of autonomic dystonia syndrome, which has a generalized character and a permanent course, are revealed in the subjects. Then, in patients with SVD, the vegetative Kerdo index (CI) is calculated using the formula (5) CI = (1-D / P) · 100, where D is the value of diastolic blood pressure,

P is the number of heart contractions.

Then, to objectify the level of autonomic influences, the spectral indicators of heart rate variability (HRV) are calculated under standard conditions according to the generally accepted methodology and existing criteria (11, 12), followed by computer analysis and automatic calculation of the necessary for studying the spectral parameters of HRV. The values obtained in absolute units and expressed in ms ² are subjected to a logarithmic transformation.

In the future, the vegetative tone index is calculated based on the known autonomic index and the value of the total spectrum power - ln Tr. The vegetative tone index is calculated as the ratio of the autonomic index to the value of the total spectrum power (VI / lnTp (ms ² )). This indicator is integral and characterizes both heart rate variability in general and reflects the direction of autonomic influences on the cardiovascular system, makes it possible to judge the severity of SVD and predict the occurrence of hemodynamic disturbances.

The obtained parameters are interpreted as follows:

1. Values of the autonomic tone index (VI / lnTp (ms ² ))> 3.1, obtained as a result of a decrease in the total power of the spectrum and registration of positive increased values of the VI, should be considered as a severe course of SVD, regarded as a state of inadequate autonomic tone in the cardiovascular a system in which the probability of developing hemodynamic disorders after a stress test is 67% and drug treatment is required.

2. The values of the vegetative tone index (VI / lnTp (ms ² )) of 3.1-2.2, obtained due to a decrease in the total spectrum power - lnTp (ms ² ) and the presence of reduced positive values of VI, should be considered as an average severity. Consider as a state of relatively adequate autonomic tone in the cardiovascular system, in which the appearance of hemodynamic disturbances after a stress test is possible in 19% of cases, and the predictive value of a negative result is 81%, requiring sanatorium-resort treatment, a course of physiotherapy exercises.

3. The values of the vegetative tone index 2.1-1.5, calculated on the basis of weakly positive, zero, slightly negative VI values and high values of the total spectrum power - lnTp (ms ² ), can be interpreted as a mild course that does not require therapeutic measures. Consider as a condition with adequate autonomic effects on the cardiovascular system, which is not accompanied by impaired hemodynamics after a stress test.

4. Values of vegetative tone less than 1.5 are considered normal.

The vegetative tone index was tested on 97 young people, among whom 25 had a severe course, 28 with an average degree of severity, 27 with a mild course and 17 made up a group with normal values of the indicator (Table 1).

Table 1
Values of vegetative tone index Vegetative tone indicator Young people (n = 97) Severe course N = 25 Moderate severity N-28 Light current N-27 Norm
N = 17 VI / lnTp (ms ² ) > 3.1 3.1-2.2 2.1-1.5 <1.5

Example 1

Young girl S. (23 years old) complained of a feeling of palpitations, feelings that she might lose consciousness in a stuffy room, sleep disturbances, redness of the face with any excitement, decreased performance, and a feeling of lack of air. During a general clinical examination of this patient, organic pathology was excluded, blood pressure (100/60), heart rate = 100 per minute. Based on complaints and objective examination data, a diagnosis of SVD is suggested. The calculation of HRV indices revealed a decrease in the total spectrum power lnTp = 7.02 (ms ² ). VI = (1-60 / 100) · 100 = 40. The index of vegetative tone (40 / 7.02) was 5.6. Considering that the patient’s vegetative tone index value is more than 3.1, she was assigned to the group with a severe course and a high risk of hemodynamic disturbances.

To determine exercise tolerance, a load test was performed on a bicycle ergometer. The sample was stopped at the 3rd minute at a threshold power of 50 W (300 kGm / min) due to fatigue, blood pressure 150/90 mm Hg, heart rate 140 / min, exercise tolerance was regarded as low. During the recovery period, an echocardiographic study was performed according to a standard method, during which a decrease in the ejection fraction (EF), degree of systolic shortening (FS), inadequate increase in the minute volume (CO) of blood, cardiac (CI) and stroke indices (SI), combined with increased total peripheral vascular resistance (OPSS). The patient is recommended to undergo a course of exercise therapy. However, after 3 weeks, studies according to the above scheme revealed previous changes (both clinical manifestations and instrumental). Subsequently, the patient underwent treatment with selective β - adrenergic blocking agents (corvitol) for 3 weeks, against the background of which she noted the disappearance of the heartbeat, feelings of lack of air, increased performance. HELL 110/70, heart rate 80 per min. An increase in the total power of the lnTp spectrum (7.1 ms ² ) and a decrease in VI to 13 were recorded. The value of the vegetative tone index corresponded to 1.8. When conducting an echocardiographic study during the recovery period after exercise, an adequate change in hemodynamic parameters was found to be consistent with the proposed load.

Example 2

Young girl V. (22 years old) complained of excessive sweating and rapid breathing with excitement, a feeling of "heartbeat", rapid fatigue. During a general clinical examination of this patient, organic pathology was excluded, blood pressure (115/65), heart rate = 82 / min. Based on complaints and objective examination data, a diagnosis of SVD is suggested. The calculation of HRV indices revealed a decrease in the total power of the lnTp spectrum, which amounted to (7.03 ms ² ). VI = (1-65 / 82) 100 = 21. The index of vegetative tone (21 / 7.03 ms ² ) was 2.9. Given the values of the index of vegetative tone, which is in the range of 3.1-2.2, this patient was diagnosed with moderate to severe SVD.

To determine exercise tolerance, a load test was performed on a bicycle ergometer. The sample was discontinued at the 3rd minute at a threshold power of 75 W (450 kGm / min) due to the achievement of a submaximum age-related heart rate of 173 / min, blood pressure of 150/80 mm Hg, and exercise tolerance was regarded as average. In the recovery period, an echocardiographic study was performed according to a standard technique. A decrease in the fraction of cardiac output (EF), stroke volume of the heart (SV).

The patient is recommended for a course of exercise therapy. After 3 weeks, studies according to the above scheme revealed a decrease in VI to 8, an increase in the total power of the lnTp spectrum to 7.3 ms ² and a vegetative tone index of VI / lnTp (ms ² ) to 1.1. Carrying out a stress test revealed an adequate load increase in indicators characterizing systolic function of the heart, a decrease in OPSS.

Example 3

Young man A. (20 years old) complained of excessive sweating during excitement, redness of the face, a tendency to headaches, difficulty breathing in a stuffy room. During a general clinical examination of this patient, organic pathology was excluded, blood pressure (125/70), heart rate = 80 / min. Based on complaints and objective examination data, a diagnosis of SVD is suggested. The calculation of HRV indices revealed a decrease in the total power of the lnTp spectrum, which amounted to 7.1 ms ² . VI = (1-70 / 80) · 100 = 12.5. The index of vegetative tone (12.5 / 7.1 ms) was 1.7. Given the values of the index of vegetative tone, which is in the range of 2.1-1.5, a diagnosis of SVD with a mild course was made.

To determine exercise tolerance, a load test was performed on a bicycle ergometer. The sample was stopped at the 3rd minute at a threshold power of 125 W (600 kGm / min) due to the achievement of a maximum blood pressure load of 155/80 mm Hg, heart rate of 133 / min, exercise tolerance was regarded as high.

In the recovery period, an echocardiographic study was performed according to a standard technique. An adequate increase in the cardiac output fraction (EF), degree of systolic shortening (FS), shock (CO) and minute volumes (SV), shock (SI) and cardiac (CI) indices, an adequate decrease in OPSS were revealed.

Based on the results, it was determined that the patient does not need to exercise physical therapy and drug treatment.

Literature:

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Claims (1)

A method for diagnosing the severity of autonomic dystonia syndrome, including determining the spectral parameters of the heart rhythm, characterized in that the vegetative index value is calculated and the vegetative tone index is calculated using the formula VI / lnTp, ms ² , where VI is the vegetative index, lnTp is the total power of the rhythm variability spectrum heart, and with indicator values> 3.1, a severe course of vegetative dystonia syndrome is diagnosed, with values of 3.1-2.2 - moderate severity, with values of 2.1-1.5 - mild course.