RU2321336C1 - Method for forming painless myocardial ischemia risk group - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves calculating total score estimate of myocardial ischemia risk factors related to availability or absence and quantitative values myocardial ischemia risk factors like total cholesterol level, low and high density lipoprotein cholesterol, triglyceride level, arterial blood pressure level, glycemia level, body mass level, strenuous activity degree with smoking habit, being of masculine sex, patient age and burdened heredity. The assigned scores give basis for diagnosing low, high or moderate painless myocardial ischemia cases.

EFFECT: high reliability in detecting risk groups.

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Description

The invention relates to medicine, in particular to assessing the state of the cardiovascular system, and can be used to identify risk groups for patients with painless myocardial ischemia (hereinafter - BIM).

The overwhelming and significant increase in variable and unchanged risk factors for coronary heart disease (hereinafter - CHD) in the overwhelming number of cases is the background state of the expanded clinical picture of coronary heart disease, which has the highest prevalence among other diseases in the world. Moreover, the highest mortality rate from coronary heart disease determines the relevance of its diagnosis (American Heart Association. Heart Disease and Stroke Statistics - 2003 Update. Dallas, Tech: American Heart Association; 2002). An algorithm for instrumental and laboratory confirmation of the clinical and anamnestic manifestations of most forms of coronary heart disease is basically defined (ACC / AHA 2002 Guidelines Update for the management of patients with chronic stable angina - summary article. A Report of the ACC / AHA Task Force on Practice Guidelines [ Committee on management of patients with chronic stable angina] Circulation 2003; 107: 149-158); (Lupanov V.P. Diagnosis and treatment of refractory angina pectoris. Russian Medical Journal 2004; V.12, No.2: 104-107).

However, in the structure of coronary heart disease there is a form of the disease that is completely devoid of clinical manifestations and has an extremely unfavorable prognostic character - this is BIM (Vertkin A.L., Martynov I.V., Gasilin BC et al. Painless myocardial ischemia. M., 1995, p. .12-14). After conducting a retrospective analysis of a large number of clinical cases, in 1987 P. Cohn proposed a BIM classification, which distinguishes: Type I - completely BIM; Type II - BIM, combined with postinfarction cardiosclerosis; Type III - BIM, combined with typical angina attacks (Cohn P. // Silent ischemia: a timely aspect in coronary artery disease. // Herz 1987. - Vol.12 - P.314-317). The identification of patients with type II and type III BIM is based on costly instrumental studies (daily monitoring of ECG, electrocardiographic stress tests, echocardiographic tests, radioisotope research methods, coronary angiography) for all patients who have had myocardial infarction and have typical angina attacks (A. Vertkin, Martynov I.V., Gasilin BC et al. Painless myocardial ischemia. M., 1995, p. 12-14). The identification of type I BIM (a completely painless form of coronary heart disease), which constitutes 15-20% of the total BIM structure and is devoid of even minimal clinical and anamnestic manifestations, is based solely on the empirical approach (Cohn PF, Fox KM Silent Myocardial Ischemia. Circulation 2003; 108: 1263 -1290).

The only criteria on the basis of which a probabilistic assessment of the presence of completely BIM can be built are the presence and a high degree of severity of risk factors for coronary heart disease. In the known works, risk factors for coronary heart disease are considered to be reliable diagnostic, to a lesser extent, and prognostic, to a greater extent, criteria within the framework of primary (elimination of variable risk factors of coronary artery disease) and secondary (elimination of manifestations of already existing coronary artery disease) coronary heart disease prevention. However, risk factors are considered only as additional markers of coronary heart disease, the main ones are still clinical and highly informative instrumental criteria of coronary heart disease (Aronov DM, Lupanov VP Diagnosis and treatment of chronic coronary heart disease. Quality of life. Medicine, 2003; No. 2: 16-24); (Karpov Yu.A., Sorokin E.V. Stable coronary heart disease: treatment strategy and tactics. - M., Reafarm. 2003-244 p.).

A known method for predicting the course of coronary heart disease (RF patent No. 2001125374), based on a combined clinical and laboratory examination of patients with coronary artery disease. The clinical component in the prediction is determined by the presence of a depressive-anxiety disorder of the patient’s mental status, and the laboratory component is determined by an increase in total cholesterol above 6.0 mmol / L, triacylglycerides above 2.2 mmol / L, an atherogenic index (ratio of low density lipoprotein cholesterol to cholesterol high density lipoproteins) more than 3.5. The disadvantages of this method are:

- the severity of depressive-anxiety disorders of mental status in patients with coronary artery disease is, to a certain extent, subjective, in addition, pronounced autonomic dysfunction, which is the basis of depressive and anxious conditions and is characterized by cardiovascular changes in heart rate variability, in a number of cases is a factor in improving the prognosis of coronary heart disease;

- an increase in the level of total cholesterol above 6.0 mmol / l and triacylglycerides above 2.2 mmol / l should be considered as insufficiently substantiated prognostically unfavorable factors, since reliably proven by numerous multicenter studies of prognostically unfavorable indicators of total cholesterol and triacylglycerides are their values above 4, 5 and 1.8 mmol / L, respectively;

- the number of three biochemical markers of IHD risk factors considered among the traditionally used thirteen is not enough for reliable objectification.

There is also a method for the diagnosis of latent coronary heart disease in patients with arterial hypertension based on an echocardiographic Doppler study performed at rest (RF patent No. 2197180). The revealed phenomena of diastolic dysfunction of the left ventricle confirm the latent IHD. The disadvantages of this method are:

- diastolic dysfunction of the left ventricle accompanies many pathological conditions and primarily hypertension, hypertrophic cardiomyopathy, heart disease in the form of aortic stenosis, and therefore cannot be considered as a pathognomonic criterion of coronary heart disease;

- the use of one indirect criterion for the presence of coronary heart disease in the form of diastolic dysfunction of the left ventricle is insufficient for reliable objectification of coronary heart disease.

Closest to the claimed invention in terms of features is a method for the diagnosis and prognosis of coronary heart disease (RF patent No. 2173853). The essence of this method is the total expression (with a correction factor for various units of components) of such serum biochemical markers as total cholesterol, low and high density lipoprotein cholesterol and their mathematical derivative - atherogenicity index, triglycerides, phenotypic assessment of the nature of dyslipoproteinemia, and anthropometric data of the patient, patient age, smoking history, myocardial infarction, presence of angina pectoris, ennogo myocardial infarction parents with the definition of prognostic index (PI). The value of PI over 1000 points allows us to predict the development of acute coronary events in patients with coronary artery disease over the next 5 years. Adopted for the prototype. The disadvantages of the prototype include the following circumstances:

- the analyzed risk factors for coronary heart disease are additional to the clinical manifestations of coronary heart disease (in the studied patients, angina pectoris, myocardial infarction suffered);

- the severity of angina pectoris is not taken into account, which is an indirect criterion for the significance of the degree of coronary atherosclerosis; the severity of post-infarction changes in the myocardium, which largely determines the prognosis of coronary heart disease, was not taken into account;

- such proven significant components as the level of blood glycemia, physical activity, blood pressure are not taken into account as risk factors for coronary heart disease;

- the quantitative values of the used risk factors for coronary heart disease are not specified;

- the genetic aspects of the inheritance of coronary heart disease are not specified (inheritance of coronary heart disease along the male, female and both parental lines).

The claimed invention is aimed at solving the problem of retrospective probabilistic assessment of the presence of BIM type I according to P. Cohn for subsequent instrumental diagnostics.

Using in clinical practice the proposed method allows to achieve several technical (therapeutic) results:

- the ability to examine a wide range of individuals in the primary outpatient diagnostic search;

- the ability to predict BIM in the preclinical stage;

- high sensitivity and specificity of patient selection for further instrumental examination of patients for the identification of BIM;

- reduction of financial costs for conducting screening electrocardiographic, echocardiographic, coronary angiographic studies.

These technical results in the implementation of the invention are achieved due to the fact that determining the likelihood of painless myocardial ischemia is carried out by determining the main risk factors for coronary heart disease: total cholesterol, low and high density lipoprotein cholesterol, triglycerides, taking into account the patient's age and burdened heredity. A feature of the invention is that it additionally determines the level of blood pressure, glycemia, body mass index, the degree of physical activity taking into account smoking and affiliation with a male or female gender, carry out a score assessment of modifiable and unmodifiable risk factors for coronary heart disease and with a total cholesterol level of less than 4 5 mmol / l, low-density lipoprotein cholesterol less than 2.6 mmol / l, high-density lipoprotein cholesterol above 2.0 mmol / l, triglycerides less than 1.3 mmol / l, arterial pressure ia below 140/90 mm Hg, glycemia less than 6.0 mmol / l, body mass index below 25 kg / m ² , high physical activity with more than 15,000 steps per day, smoking cessation, lack of adverse heredity, affiliation to the female sex, the age of women less than 55 years old, the age of men less than 45 years old - each of these criteria is assigned a value of 0 points, with a total cholesterol level of 4.5 to 5.5 mmol / l, low density lipoprotein cholesterol from 2.6 to 3.5 mmol / l, high density lipoprotein cholesterol from 2.0 to 1.4 mmol / l, t riglycerides from 1.3 to 1.9 mmol / l, blood pressure from 140/90 to 160/100 mm Hg, glycemia from 6.1 to 7.9 mmol / l, body mass index from 25 to 27 kg / m ² , moderate physical activity with the number of steps from 10.000 to 15.000 per day, smoking up to 5 cigarettes per day, the presence of adverse heredity for men on the male line and for women on the female line, male gender, women age 55 to 62 years, the age of men from 45 to 54 years - each of the listed criteria is assigned a value of 1 point, with a total cholesterol level of from 5.6 to 6.9 mmol / l, low density lipoprotein cholesterol from 3.6 to 4.5 mmol / l, high density lipoprotein cholesterol from 1.4 to 1.0 mmol / l, triglycerides from 2.0 to 2.4 mmol / l, blood pressure from 160/100 to 180/110 mm Hg, glycemia above 8.0 mmol / l, body mass index from 27 to 29 kg / m ² , reduced physical activity with the number of steps from 6.000 to 9.000 per day, smoking from 6 up to 15 cigarettes per day, the presence of adverse heredity for men in the female line and for women in the male line, the age of women from 63 to 68 years old, the age of men from 55 to 64 years old - to each of the listed criteria are assigned a value of 2 points, with a total cholesterol level of over 7.0 mmol / L, low density lipoprotein cholesterol over 4.6 mmol / L, high density lipoprotein cholesterol less than 1.0 mmol / L, triglycerides over 2.5 mmol / l, blood pressure above 180/110 mm Hg, daily glycemic dispersion of more than 5.0 mmol / l (with 3-fold measurement of glycemia, determined at least 2 hours after eating), body mass index over 30 kg / m ² , low physical activity with less than 6.000 steps per day, smoking more than 15 whitefish ret daily, the presence of adverse heredity between both parents, women over 69 years old, men over 65 years old - each of these criteria is assigned a value of 3 points and the total probability coefficient for the presence of BIM is calculated by the formula:

∑KVBIM-OHb + HSLPNPb + HSLPVPb + Tgb + ADb + Gl.b + IMTb + FAb + Kb + NFb + M / Zhb + Age.

where ∑KVBIM - total probability coefficient of the presence of BIM;

OXb - a score for the level of total cholesterol;

KSLPNPb - a low-density lipoprotein cholesterol score;

KSLPVPb - scoring of high density lipoprotein cholesterol;

Tgb - scoring of triglycerides;

ADB - point assessment of blood pressure;

Ch. B - a glycemic level score;

BMI - score for body mass index;

FAB - point assessment of the degree of physical activity;

Kb - smoking score;

NFb - point assessment of hereditary factors;

M / Zhb - point assessment of gender;

Age b - age score.

With ∑KVBIM less than 12 points, the probability of having BIM is estimated as low, with ∑KVBIM from 13 to 25 points, the probability of having BIM is estimated as moderate, with ∑KVBIM from 26 to 37 points, the probability of having BIM is estimated as high.

The invention consists in the following.

It was established that the presence or absence of type I BIM by P. Cohn is primarily associated with the presence, severity and extent of coronary atherosclerosis, as well as with the total value of certain qualitative and quantitative characteristics of IHD risk factors. The authors proposed to carry out a scoring of the main modifiable risk factors for CHD:

- total cholesterol level,

- low and high density lipoprotein cholesterol level,

- triglyceride level,

- blood pressure level,

- the level of glycemia,

- body mass index,

- degree of physical activity,

- smoking

and non-modifiable risk factors for CHD:

- burdened by heredity,

- belonging to a male or female gender,

- age of the patient.

With a total cholesterol level of less than 4.5 mmol / L, low-density lipoprotein cholesterol less than 2.6 mmol / L, high-density lipoprotein cholesterol above 2.0 mmol / L, triglycerides less than 1.3 mmol / L, blood pressure below 140 / 90 mmHg, glycemia less than 6.0 mmol / l, body mass index below 25 kg / m ² , high physical activity with more than 15,000 steps per day, smoking cessation, lack of adverse heredity, female gender, women less than 55 years old, men less than 45 years old - each of which is listed s criteria evaluate to 0 points.

With a level of total cholesterol from 4.5 to 5.5 mmol / L, low-density lipoprotein cholesterol from 2.6 to 3.5 mmol / L, high-density lipoprotein cholesterol from 2.0 to 1.4 mmol / L, triglycerides from 1.3 to 1.9 mmol / L, blood pressure below 160/100 mm Hg, glycemia from 6.1 to 7.9 mmol / L, body mass index from 25 to 27 kg / m ² , moderate physical activity with the number of steps from 10,000 to 15,000 per day, smoking up to 5 cigarettes per day, the presence of adverse heredity for men in the male line and for women in the female line, male gender , The age of women from 55 to 62 years, men aged 45 to 54 years - each of these criteria is estimated at 1 point.

At a level of total cholesterol from 5.6 to 6.9 mmol / L, low-density lipoprotein cholesterol from 3.6 to 4.5 mmol / L, high-density lipoprotein cholesterol from 1.4 to 1.0 mmol / L, triglycerides from 2.0 to 2.4 mmol / L, blood pressure below 180/110 mm Hg, glycemia above 8.0 mmol / L, body mass index from 27 to 29 kg / m ² , reduced physical activity with the number of steps from 6.000 to 9.000 per day, smoking from 6 to 15 cigarettes per day, the presence of adverse heredity for men on the female line and for women on the male line, the age of women from 63 to 68 years, ozraste men from 55 to 64 years - each of these criteria is estimated at 2 points.

When the level of total cholesterol is more than 7.0 mmol / l, low-density lipoprotein cholesterol is more than 4.6 mmol / l, high-density lipoprotein cholesterol is less than 1.0 mmol / l, triglycerides are greater than 2.5 mmol / l, blood pressure is higher than 180 / 110 mmHg, daily glycemic dispersion of more than 5.0 mmol / l (with 3-fold measurement of glycemia, determined at least 2 hours after a meal), body mass index over 30 kg / m ² , low physical activity with the number of steps less than 6.000 per day, smoking more than 15 cigarettes per day, the presence of adverse heredity for both parents, women over 69 years old, men over 65 years old - each of the above criteria is rated at 3 points.

The score for the probability of the presence of BIM is presented in Table 1.

Table 1
BIM Probability Score Indicator Level / points OH, mmol / l Less than 4,5 4,5-5,5 5.6-6.9 7.0 and above 0 one 2 3 LDL cholesterol, mmol / l Less than 2.6 2.6-3.5 3.6-4.5 4.6 and up 0 one 2 3 HDL cholesterol, mmol / l More than 2.0 1.9-1.4 1.4-1.0 1.0 and less 0 one 2 3 TG, mmol / l Less than 1.2 1.3-1.9 2.0-2.4 2.5 and above 0 one 2 3 HELL, mmHg Less than 140/90 140 / 90-160 / 100 160 / 100-180 / 110 Above 180/110 0 one 2 3 Glycemia, mmol / l Less than 6.0 6.1-7.9 Above 8.0 Daily glycemic dispersion of more than 5 (3-fold measurement of glycemia not less than 2 hours after eating) 0 one 2 3 BMI, kg / m ² Less than 25 25-27 27-29 30 and above 0 one 2 3 Physical activity, steps per day More than 15 thousand 10-15 thousand 6-9 thousand Less than 6 thousand 0 one 2 3 Adverse Heredity + (men on the male line; women on the female line) ++ (men on the female line; women on the male line) +++ (the sign is traced in both parents) 0 one 2 3 Male or female - + 0 one Age (men), years Less than 45 45-54 55-64 Over 65 0 one 2 Age (women), years Less than 55 55-62 63-68 Over 69 0 one 2 3 Smoking, the number of cigarettes per day - Less than 5 6-15 More than 15 0 one 2 3 Possible total score Less than 12 13-25 26-37

After carrying out the above studies, a point assessment of each of the risk factors for coronary heart disease is carried out and the total probability coefficient for the presence of BIM is calculated by the formula:

∑KVBIM = ОХб + ХСЛПНПб + ХСЛПВПб + ТГб + АДб + Гл.б + ИМТб + ФАб + Кб + НФб + М / Жб + А.б,

where ∑KVBIM - total probability coefficient of the presence of BIM;

OXb - a score for the level of total cholesterol;

KSLPNPb - a low-density lipoprotein cholesterol score;

KSLPVPb - scoring of high density lipoprotein cholesterol;

Tgb - scoring of triglycerides;

ADB - point assessment of blood pressure;

Ch. B - a glycemic level score;

BMI - score for body mass index;

FAB - point assessment of the degree of physical activity;

Kb - smoking score;

NFb - point assessment of hereditary factors;

M / Zhb - point assessment of gender;

Age b - age score.

Patients with ∑KVBIM score of 12 points or less can be assigned to the low-risk group; they are unlikely to have BIM. Conducting instrumental studies in this group of patients is not shown. Patients with ∑KVBIM range from 13 to 25 points can be classified as moderate risk, the likelihood of BIM is estimated as average. This group of patients is shown conducting instrumental studies. Patients with ∑KVBIM more than 25 points, can be classified as high risk, the likelihood of having BIM is rated as high. Carrying out instrumental studies is mandatory for this group of patients.

The use of the proposed method provides high sensitivity and specificity for the selection of patients for further instrumental examination for the identification of BIM through a score of risk factors for coronary heart disease. Moreover, a large number of risk factors for coronary heart disease and a high degree of their severity determine the high sensitivity of the method, and analysis of a large number of risk factors for coronary heart disease with a low degree of severity (or lack thereof) determines the high specificity of the method. The proposed point estimate, based on the use of a large number of criteria and their severity, is the basis for obtaining a comprehensive diagnostic indicator that allows highly sensitive selection of patients for instrumental research methods in patients with suspected presence of BIM with a further high degree of probability of its confirmation. At the same time, the reliability of the presence of IHD in some patients can be confirmed without the use of expensive instrumental techniques (primarily coronary angiography).

To develop the proposed method, 625 case histories of patients completely deprived of pain in the chest area or their equivalents, which in 1998-2005, were retrospectively analyzed. coronary angiography was performed. In this case, the study group did not include patients with postinfarction cardiosclerosis, typical angina attacks and an echocardiographic coefficient of the relative thickness of the left ventricular wall in diastole of more than 0.45. Evaluation of the results of coronary angiography was carried out on a scale depending on the degree of blood flow disturbance for a particular segment of the coronary bed and the number of segments of the coronary bed in which blood flow was impaired (Sheehan FH, Braunwald E., Canner P., et al. The effect of intravenous thrombolytic therapy on left ventricular function: a report on tissue-type plasminogen activator and streptokinase from the Thrombolysis In Myocardial Infarction (TIMI Phase I) trial. Circulation 1987; 75: 817-829) (Alderman EL, Stadius M. The angiographic definitions of the Bypass Angioplasty Revascularization Investigation study (BARI) Coron. Artery Dis. 1992; 3: 1189-1207). And then the point scale of coronary blood flow disturbance was compared with qualitative and quantitative indicators of IHD risk factors according to the criteria of covariance multivariate analysis with determination of the quantitative values of each of the indicators of probability-theoretical components (risk factors of IHD). During the study, a direct correlation was revealed between the studied risk factors and the results of the coronary angiographic studies. In the course of the study, it was found that the scoring of coronary lesions is directly proportional to increase with the increase in the number and severity of the studied risk factors for coronary heart disease.

A comprehensive assessment of the probability of BIM was calculated for all 625 patients participating in the study. The results obtained made it possible to determine the specificity of individual signs (risk factors for coronary heart disease), the sensitivity of which with a maximum lesion of the coronary channel and the maximum severity of risk factors reached 94%, and specificity (in the absence of a diagnostically significant lesion of the coronary channel and minimal severity (or absence) of risk factors) reached 89%.

The method can be successfully applied to solve various diagnostic problems. The main area of practical application of the proposed method is the development of qualitative and quantitative criteria for the formation of a patient risk group for further instrumental confirmation of the presence of the painless form of coronary heart disease in the primary outpatient unit of a diagnostic search. The average accuracy of the method proposed by the authors, calculated as the arithmetic average of the maximum sensitivity values (the presence of the most pronounced common coronary atherosclerosis according to coronary angiography with a maximum score of IHD risk factors) and specificity (the absence of signs of coronary atherosclerosis according to coronary angiography with a minimum score of IHD risk factors) is 81%. The proposed method can be used during routine medical examinations as a screening selection of possible patients to identify transient myocardial ischemia and further confirmation of painless coronary artery disease without involving expensive diagnostic instrumental techniques.

The proposed method for the diagnosis of coronary heart disease is illustrated by the following clinical examples identified during a routine medical examination of employees of a federal state-owned enterprise.

Example 1. In a patient F-va N.V., 39 years old, not presenting complaints, during the medical examination revealed:

Table 2 Indicator Level Points Age years 39 0 Floor m one Total cholesterol, mmol / l 7.2 3 Low density lipoprotein cholesterol, mmol / L 4.9 3 High density lipoprotein cholesterol, mmol / L 0.9 3 Triglycerides, mmol / L 2,8 3 HELL, mmHg 165/100 2 Glycemia, mmol / l 8.1 2 BMI, kg / m ² 31.5 3 Physical activity, steps per day About 4000 3 Heredity ++ 2 Smoking, the number of cigarettes per day More than 20 3 The total score of the probability of the presence of BIM, ∑KVBIM 28

Given the high total ΣKVBIM score of 28 points, the patient was recommended to conduct a treadmill test to detect transient myocardial ischemia, however, the patient’s study was not brought to the criteria for a positive test because of his fatigue. A coronary angiography was performed on the patient, which revealed a two-vessel stenosing lesion of the coronary arteries (quantitative assessment by Sheehan F.H., Braunwald E., 1987; Alderman E.L, Stadius M., 1992 - 30 points). Subsequently, the patient underwent a coronary artery bypass grafting with four autologous graft shunts with a positive clinical and control coranographic result.

Example 2. In a patient St. VA 56 years, not presenting complaints, during the medical examination revealed:

Table 3 Indicator Level Points Age years 56 one Floor m one Total cholesterol, mmol / l 5,6 2 Low density lipoprotein cholesterol, mmol / L 3.8 2 High density lipoprotein cholesterol, mmol / L 1,5 one Triglycerides, mmol / L 1,6 one HELL, mmHg 150/100 one Glycemia, mmol / l 6.2 one BMI, kg / m ² 28 2 Physical activity, steps per day About 7000 2 Heredity ++ 2 Smoking, the number of cigarettes per day More than 20 3 The total score for the probability of the presence of BIM = ∑KVBIM 19

Given the ∑KVBIM score of 19 points, the patient is recommended to conduct an ECG stress test to detect transient myocardial ischemia. According to the results of daily monitoring of the electrocardiogram, the patient showed no signs of transient myocardial ischemia, however, the maximum intensity of physical activity performed during monitoring did not allow to reach submaximum age-related heart rate values. When conducting a treadmill test against the background of achieving a load of 50 W, the patient had an increase in blood pressure to 220/120 mm Hg, and therefore the load was stopped. After carrying out antihypertensive therapy in a hospital for 7 days, the patient underwent coronary angiography, which revealed damage to the coronary arteries with a 40% narrowing of the distal segment of the right coronary artery, with a 60% narrowing of the segment of the posterior descending artery and 70% of narrowing in the right posterior atrioventricular segment (quantitative assessment according to Sheehan FH, Braunwald E., 1987; Alderman EL, Stadius M., 1992 - 19 points). Given the anatomical features of coronary lesions, it was decided to abstain from surgical myocardial revascularization. The patient was prescribed conservative therapy with beta-blockers, antiplatelet agents, ACE inhibitors and statins.

Example 3. In a patient P-whom V.I., 69 years old, during a medical examination presenting complaints of sharp piercing pain in the left half of the chest, arising from a deep inspiration and rotation of the body, it was revealed:

Table 4 Indicator Level Points Age years 69 3 Floor m one Total cholesterol, mmol / l 4.3 0 Low density lipoprotein cholesterol, mmol / L 2,3 0 High density lipoprotein cholesterol, mmol / L 2.0 0 Triglycerides, mmol / L 1,1 0 HELL, mmHg 130/80 0 Glycemia, mmol / l 5.1 0 BMI, kg / m ² 24.7 0 Physical activity, steps per day About 15000 0 Heredity +++ 3 Smoking, the number of cigarettes per day - 0 The total score for the probability of the presence of BIM = ∑KVBIM 7

In order to clarify the nature of the pain syndrome in the chest area, the patient underwent electrocardiographic studies (resting ECG, Holter monitoring of the electrocardiogram), in which there were no signs of transient myocardial ischemia; X-ray of the cervical and thoracic spine, which revealed signs of osteochondrosis of the cervical and thoracic spine. Regarding osteochondrosis of the spine, the patient was consulted by a neurologist, treatment was prescribed. ∑KVBIM in this patient was 7 points, however, taking into account the patient’s age, the presence of adverse heredity, the patient underwent coronary angiography on which no diagnostically significant coronary atherosclerosis was detected (quantitative assessment by Sheehan FH, Braunwald E., 1987; Alderman EL, Stadius M., 1992 - 9 points).

Thus, the proposed scoring method for selecting patients for further instrumental studies in patients with completely painless manifestations of coronary heart disease can significantly increase the likelihood of a positive test for coronary artery disease without resorting to costly instrumental studies in a screening mode.

Claims (1)

A method for determining the likelihood of painless myocardial ischemia, including determining the main risk factors for coronary heart disease: total cholesterol, low and high density lipoprotein cholesterol, triglycerides, taking into account the patient’s age and burdened heredity, characterized in that they additionally determine the level of blood pressure, glycemia, body mass index, degree of physical activity taking into account smoking and affiliation with a male or female gender, carry out a score assessment of the modif identifiable and non-modifiable risk factors for coronary heart disease and with a total cholesterol level of less than 4.5 mmol / l, low-density lipoprotein cholesterol less than 2.6 mmol / l, high-density lipoprotein cholesterol above 2.0 mmol / l, triglycerides less than 1.3 mmol / l, blood pressure below 140/90 mm Hg, glycemia less than 6.0 mmol / l, body mass index below 25 kg / m ² , high physical activity with more than 15,000 steps per day, smoking cessation, no adverse heredity, female, women less than 55 years old, age aste men less than 45 years old - each of these criteria is assigned a value of 0 points, with a total cholesterol level of 4.5 to 5.5 mmol / l, low density lipoprotein cholesterol from 2.6 to 3.5 mmol / l, high lipoprotein cholesterol density from 2.0 to 1.4 mmol / l, triglycerides from 1.3 to 1.9 mmol / l, blood pressure from 140/90 to 160/100 mm Hg, glycemia from 6.1 to 7, 9 mmol / l, body mass index from 25 to 27 kg / m ² , moderate physical activity with the number of steps from 10,000 to 15,000 per day, smoking up to 5 cigarettes per day, the presence of an adverse inheritance values for men in the male line and for women in the female line, male gender, the age of women from 55 to 62 years old, the age of men from 45 to 54 years old - each of these criteria is assigned a value of 1 point, with a total cholesterol level of 5, 6 to 6.9 mmol / l, low density lipoprotein cholesterol from 3.6 to 4.5 mmol / l, high density lipoprotein cholesterol from 1.4 to 1.0 mmol / l, triglycerides from 2.0 to 2.4 mmol / l, blood pressure from 160/100 to 180/110 mm Hg, glycemia above 8.0 mmol / l, body mass index from 27 to 29 kg / m ² , decreased physical activity with the number of steps from 6.000 to 9.000 per day, smoking from 6 to 15 cigarettes per day, the presence of adverse heredity for men on the female line and for women on the male line, the age of women from 63 to 68 years, the age of men from 55 to 64 years - each of these criteria is assigned a value of 2 points, with a total cholesterol level of more than 7.0 mmol / l, low density lipoprotein cholesterol over 4.6 mmol / l, high density lipoprotein cholesterol less than 1.0 mmol / l, triglycerides over 2 5 mmol / L, blood pressure in Chez 180/110 mmHg dispersion daily glycemia more than 5.0 mmol / l - at 3-fold measuring glycemia determined not less than 2 hours after eating, body mass index above 30 kg / m ^2, low physical activity with less than 6.000 steps per day, smoking more than 15 cigarettes a day, the presence of adverse heredity between both parents, women over 69 years old, men over 65 years old - each of these criteria is assigned a score of 3 and the total probability coefficient of availability is calculated painless ischemia m okarda by the formula: = ΣKVBIM AECB HSLPNPb + + + HSLPVPb TGB DAS + + + Gl.b IMTb + FAB + Kb + NSE + M / RC + Vozr.b where ΣKVBIM - total coefficient of the probability of existence of silent myocardial ischemia; OXb - point assessment of total cholesterol; KSLPNPb - a low-density lipoprotein cholesterol score; KSLPVPb - scoring of high density lipoprotein cholesterol; Tgb - scoring of triglycerides; ADB - point assessment of blood pressure; Ch. B - a glycemic level score; BMI - score for body mass index; FAB - point assessment of the degree of physical activity; Kb - smoking score; NFb - point assessment of hereditary factors; M / Zhb - point assessment of gender; Age - a point estimate of age, with ECVBIM less than 12 points, the probability of having painless myocardial ischemia is considered low, with ВCVBIM from 13 to 25 points, the probability of having painless myocardial ischemia is considered moderate, with ,CVBIM from 26 to 37 points, the probability of having a painless myocardial ischemia is considered high.