RU2350273C2 - Method of early stages of atherosclerosis diagnostics - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, namely an ultrasonic method of research. A pulse-wave Doppler scanning of the general carotid is performed on distance of 1 centimetre more proximally of its bifurcation, peak systolic rates of a blood flow are defined immediately at a wall (V_w) and in the vessel centre (V_c), a relation V_w/V_c is counted at which value less than 0.89 shows an atherosclerosis.

EFFECT: method dilates an arsenal of agents for diagnostics of early stages of an atherosclerosis.

2 tbl, 5 ex, 2 dwg

Description

The invention relates to medicine, namely to an ultrasonic research method, can be used for early diagnosis of atherosclerosis and thereby prevent disability and mortality of patients.

Atherosclerosis is currently recognized as the leading cause of death in both high-living and developing countries. Its complications lead to cerebral infarction and coronary heart disease, disability and disability (Shmyrev V.I., 2001, Gusev E.I., 2003). This is the most common form of vascular pathology with a huge range of clinical manifestations, which, being a multifocal disease, rarely affects only one vascular pool. The most dangerous localization of atherosclerotic plaques are the vessels of the heart and brain (Schmidt E.V., 1979, Shirokov EA, 2001). The debut stages of stenotic lesions most often occur slightly or asymptomatically. But there is an opinion that it is small, but not large plaques that are more likely to lead to acute clinical events in the event of a sudden occlusion of the lumen with a thrombus (Fuster V., Levis A., 1994, Danchin N., 1993). It is obvious that the timely detection of coronary or carotid atherosclerosis determines the fate of a patient who needs active medication or surgical treatment (Pokrovsky V.I., 2003, Vereshchagin N.V. 2003, Fedin A.I. 2004).

Currently, the “gold standard” for the diagnosis of atherosclerotic lesions of the arteries is radiopaque angiography (Volf K.-J., Fobbe F., 1999, Polak J.F., 1992). However, to identify early changes, it is not informative enough. Intravascular ultrasound examination shows that segments of arteries that look normal during angiographic examination may still contain atherosclerotic plaques (Goar F., Pinto F., Alderman E. et al., 1992). In addition, the disadvantages of the method are invasiveness, an increased risk of complications and radiation exposure.

Ultrasonic duplex scanning allows you to measure the thickness of the intima-media complex (CMM) of the wall of large vessels. At values exceeding 1.0 mm for the common carotid and 1.2 mm for the common femoral arteries, an atherosclerotic lesion is diagnosed (Lelyuk V.G., Lelyuk S.E., 2003). This is the most common way to diagnose it, however, with the aging of healthy arteries, diffuse thickening of their inner layer also occurs due to the accumulation of smooth muscle cells and connective tissue (Orekhov A.N., 1984). The study of autopsy samples of the human aorta showed that the quantitative relationships of aging and atherosclerosis cannot be divided (Komissarenko I.A., Mikheeva O.M., 2004). Thus, it is important for the researcher to differentiate diffuse age-related changes in the normal artery from the focal formation of fibro-muscular plaques, which significantly depends on experience and qualifications. In addition, the disadvantage of this method is that the diagnosis is performed at the stage when structural changes have already occurred in the artery wall that are not amenable to reverse development.

To diagnose small changes in the wall of the coronary arteries, intravascular ultrasound is successfully used (Demin V.V., Zelenin V.V., Zheludkov A.N., 2003). Using a catheter, a miniature sensor is inserted into the lumen of the vessel and allows accurate verification of even minor atherosclerotic plaques. Together with all the advantages, this procedure remains extremely expensive, time-consuming and invasive (Karpov R.S., Pavlyukova E.N., Vrublevsky A.V. et al., 2006).

A known method for the diagnosis of atherosclerosis (Patent No. 94011332, 1996.05.20), which consists in the fact that when examining the femoral artery in the area of fusion of the superficial and deep femoral veins with the zone of interest in the artery wall and adjacent paravasal tissue, the value of the most common pixels in the studied area (L) relative to the projection of this point, divide the base of the gray scale into two intervals, expressed in units of the scale, determine the ratio of the segment from the beginning of the scale to the projection of point L to the value of the cut atherosclerosis is diagnosed from this point to the end of the curve and with an increase in this indicator compared with the norm. The disadvantage of this method is the subjectivity of assessing the values of the most common pixels and its dependence on the experience of the researcher.

The largest number of common features with the claimed features contains a method for assessing the volume distribution of blood flow in vessels (Patent No. 94045540, 1996.10.27), which is adopted as a prototype. It is indicated that it can be used to diagnose diseases of the vascular system, including atherosclerosis of peripheral arteries. The method consists in the following: by means of ultrasound scanning, the cardiac and stroke vascular volume of blood is determined, and the blood flow distribution is calculated by the formula KRK = UO _with J + ... + UO _with N / UO _ser , where KK is the distribution coefficient of blood flow; UO _sos - vascular stroke volume; UO _ser - heart stroke volume; N is the number of vessels from 1 to n; and the change in CRC in comparison with the norm assesses the state of blood flow. However, it must be taken into account that a violation of the volume distribution of blood flow occurs only with a significant, hemodynamically significant damage to the artery, while it is desirable to identify small changes. In addition, additional time is required to determine parameters and carry out calculations.

The disadvantages of the above methods are eliminated in the claimed invention.

The objective of the invention is the development of a fairly simple, quick and non-invasive method for the diagnosis of atherosclerotic vascular lesions, starting from its early stages.

The problem is solved in that during ultrasound examination of the common carotid artery in its longitudinal section 1 cm proximal to the bifurcation using a pulse-wave Doppler scan with a control volume of 1 mm, first determine the peak systolic velocity of the parietal blood flow at the posterior wall (V _st ), and then the peak systolic velocity of the central layer (V _c ). The ratio of V _article / V _C less than 0.89 is a sign of the presence of atherosclerotic vascular lesions in this subject.

The presented drawing schematically shows the position of the control volume of the pulse-wave Doppler in the lumen of the common carotid artery when determining the peak systolic velocity of the parietal (Fig. 1) and the central layer of blood flow (Fig. 2).

A positive technical result obtained as a result of the practical use of the proposed method is as follows:

- the method allows at an early stage to assess the presence of atherosclerosis and identify a group of patients who need additional examination and prevention, which reduces the cost of treating complications, reduces disability and mortality;

- the method is simple, accessible in use, requires a minimum amount of time spent, safe for the patient and researcher, which makes it possible to use it to control treatment.

At least several dozen hypotheses are known that explain the origin and progression of the atherosclerotic process. However, to date, not one of them, even the most popular and reasoned, is considered universally recognized and conclusively proven.

Experimental data of recent years have shown that the leading role in atherogenesis belongs to the state of the endothelium, which is a semi-selective barrier to the diffusion of macromolecules from the lumen of the vessel into the interstitial space (Blann A.D., 2000, Lip G.Y.H., 1998, Harrison D.G., 1997). The main protective role in intact endothelium is assigned to nitric oxide - NO, which ensures vasodilation, inhibition of the expression of adhesion molecules, as well as platelet aggregation, antiproliferative, antiapoptotic and antithrombotic effects. In places of turbulent blood flow, normal (along the vessel) orientation of endothelial cells is disrupted and NO emission decreases (Luscher T.F., Tschudi M.R., Wenzel R.R., Noll G., 1997). It is the hemodynamic factor that is considered one of the main in the initiation of atherosclerotic vascular lesions. The predominant localization of lipid spots has been proved in strictly defined places - in the area of bifurcations, branching of arteries, in convoluted areas and in areas above narrowing, that is, where flow turbulence is especially pronounced (Pigarevsky N.P., 1986).

In a turbulent flow, blood elements (layers) make disordered movements along complex paths, which leads to intense mixing between layers of a moving fluid. The degree of turbulence depends mainly on the degree of roughness of the vessel surface, the presence of bends or changes in the diameter of the vessel, as well as on the Reynolds number, which is directly proportional to the radius of the vessel, linear velocity of blood flow, blood density and inversely proportional to blood viscosity (Aleshkevich V.A., Dedenko L. .G., Karavaev V.A., 1998).

Since particles of a fluid moving in a vessel “stick” to the walls, the speed of the layers of the flowing fluid will be different - from zero at the surface to a maximum in the center (Aleshkevich V.A., Dedenko L.G., Karavaev V.A. ., 1998). In the case of a laminar or layered flow, the forces of viscosity smooth out the lateral movements of the liquid, which arise as a result of various irregularities in the walls. The speed difference between adjacent layers does not differ significantly.

With an increase in the roughness of the wall, additional resistance to the movement of the parietal layers arises, and the velocity of blood in the parietal layer slows down. Therefore, the central layers in a large vessel will move much faster than the parietal. The difference in velocities of adjacent layers enhances lateral particle motions, and this leads to a transition to a turbulent flow.

Even minor lesions of the arteries, usually assessed as “hemodynamically insignificant,” have a huge impact on the energy of blood circulation, and therefore on hemodynamics. This lesion may not cause pronounced changes in blood circulation at rest, but may occur during exercise, changes in blood viscosity, hematocrit, etc. (Spiridonov A.A., Lavrentiev A.V., Morozov K.M., 2000). On this basis, we considered it promising to develop a new method for the diagnosis of the initial stages of atherosclerosis, which is based on the detection of differences in the speed regimes of the parietal and central layers in large arteries.

When examining patients using the claimed method, in addition to conducting an ultrasonic triplex study of the carotid arteries with subsequent calculation of the turbulence index, anamnestic data, electrocardiograms, and radiopaque angiography data were also analyzed. Attention was drawn to the fact that in all patients with significant myocardial infarction or the presence of even minor atherosclerotic plaques on the angiogram, the ratio of V _st / V _c was less than 0.89. However, patients with a ratio of V _st / V _c more than 0.9, aimed at angiography for pain in the region of the heart, did not have signs of atherosclerosis both in the coronary vessels and in other vascular pools. With a more detailed examination, the cause of heart pain in them turned out to be non-coronarogenic factors: osteochondrosis, rheumatic stenosis of the aortic valve, etc.

The inventive method allows the diagnosis of atherosclerosis before the visualized thickening of the complex intima-media. We analyzed the value of V _st / V _c in patients with normal CMM of the common carotid artery (less than 1.0 mm) and with a thickening of more than 1.0 mm, which is usually considered a marker of atherosclerosis. The data obtained are presented in table 1.

Table 1 Clinical and morphological characteristics of patients with different thicknesses of the intima-media complex CMM, mm <1.0 ≥1.0 V _cn / V _c ≥0.9 ≤0.89 ≥0.9 ≤0.89 Group number one 2 3 four Number of patients 26 27 8 49 Age, l 54.3 ± 13.9 55.1 ± 10.4 56.3 ± 2.06 56.5 ± 9.34 Total serum cholesterol, mmol / l 5.08 ± 0.89 5.44 ± 0.86 5.18 ± 0.7 5.33 ± 0.83 OCA diameter, mm 6.02 ± 0.73 ⁴ 5.79 ± 0.65 ⁴ 6.25 ± 0.66 6.56 ± 0.66 ¹ , ² Angina pectoris, FC 0 1.2 ± 0.1 ⁴ 0 2.3 ± 0.2 ² Average% coronary angiography stenosis 0 72.5 ± 9.6 ⁴ 0 83.7 ± 8.3 ² Note: ^1,2,3,4 - p <0,05 when compared with the corresponding indicators of this group.

The selected groups were comparable in terms of basic demographic indicators (age and gender). Serum cholesterol did not differ in groups. The diameter of the common carotid artery was significantly large only in the group of patients with CIM ≥1.0 mm and V _st / V _c ≤0.89 - 6.56 ± 0.66 mm.

The most important circumstance was that in patients with normal CMM and a ratio of V _st / V _c less than 0.89, reliable signs of coronary atherosclerosis were recorded - the average percentage of stenosis was 72.5 ± 9.6. At the same time, in a small number of patients with a thickening of the intima-media complex and a ratio of V _st / V _c more than 0.9, a detailed clinical and instrumental examination showed no signs of atherosclerosis and angina pectoris.

Thus, the proposed method is an earlier marker of vascular atherosclerosis than the value of CMM.

The relationship of atherosclerotic lesions of the brachial, carotid and coronary arteries was studied by Sorensen K.E. et al., 1997. They examined segments of the brachial, carotid, and coronary arteries taken during autopsy in 52 patients. The presence of fat strips was attributed to a minor lesion (1 degree), fibrous plaques - to 2 degrees, and more significant changes to 3 degrees. A picture of one of the three degrees of atherosclerosis was found in the brachial artery (PA) in 39 (75%) patients, in the common carotid artery (OCA) in 51 (98%) patients, in coronary arteries - in 100% of patients. All three studied arteries are characterized by a progression of changes with the age of the patients. The authors concluded that PA damage is highly correlated with similar changes in the OCA and coronary arteries, especially in people younger than 50 years old.

Therefore, a decrease in the ratio of V _st / V _c less than 0.89 can be used not only to diagnose changes in the studied artery, but also as an indirect sign of a general atherosclerotic vascular lesion in a particular subject, as a predictor of possible cardiovascular complications - heart attack and stroke.

The method is implemented as follows. Ultrasound examination is performed on a device of high or expert class, equipped with a linear sensor with a frequency of 7.5 to 10.0 MHz and a Doppler unit. An important condition is the ability to change the value of the control volume. Prior to performing the procedure, it is necessary that the patient stay in a horizontal position for at least 10 minutes. Then, in the B-mode, a longitudinal section of the right common carotid artery is found. At a distance of 1 centimeter proximal to its bifurcation with a control volume of 1 mm, a pulse-wave Doppler study is performed with the measurement of peak systolic velocity first directly near the wall farthest from the sensor (V _st ), and then in the center of the vessel (V _c ). Their ratio V _st / V _{c is} calculated.

With a ratio of V _st / V _c more than or equal to 0.9, atherosclerotic vascular damage is considered unlikely.

A value of V _st / V _c less than 0.89 is considered a sign of the presence of atherosclerosis.

The performance of the proposed method is confirmed by the following examples.

Example 1

Patient K-va, 56 years old (medical history No. 2408), was admitted to the cardiology department of the Regional Clinical Hospital. NN Burdenko, Penza with complaints of pain of a pressing nature behind the sternum, which appear in the cold and after a high-intensity load, lasts 10-15 minutes. Pain at rest and no shortness of breath. From the anamnesis revealed that the described seizures appeared 1 month ago. Not examined, not treated. The patient's father suffered a myocardial infarction at the age of 52 years. The patient does not smoke, leads a mobile lifestyle, denies the presence of diabetes mellitus, myocardial infarction and strokes in the past.

An objective study - blood pressure 110/70 mm Hg, heart rate 65 beats. in min., heart sounds are muffled, rhythmic, no noise. Vesicular respiration over the lungs. The liver and spleen are not enlarged. No swelling. ECG at rest - sinus rhythm, correct, no rhythm, conduction, signs of ischemia. With echocardiography, the cavities of the heart are not expanded, the diastolic dysfunction of the left ventricle is hypertrophic, the mass of the left ventricular myocardium and its contractility are normal, and there have been no violations of local contractility.

Conducting load functional tests was not shown due to the presence of clinically unstable angina.

Triplex scanning of carotid arteries. Peak systolic velocity of parietal blood flow was 78.6 cm / s, central blood flow - 106.0 cm / s., The ratio of V _st / V _C 0.74. Complex intima-media 0.7 mm, stenosis of the carotid arteries were not detected.

Given the high risk of atherosclerosis according to the study, the patient underwent coronarography. Conclusion: the right type of blood supply to the myocardium, isolated critical short stenosis of proximal UML.

Diagnosis: ischemic heart disease. Unstable angina pectoris. CHF 0 tbsp.

The conclusion is made on the advisability of agency of permanent residence, which was successfully implemented. At discharge, there were no complaints, with an objective examination of blood pressure 120/80 mm Hg, heart rate 63 beats. in min, a turbulence index of 0.82. Thus, timely diagnosis made it possible to significantly improve the patient's condition and to avoid the development of myocardial infarction.

Example 2

Patient K-in, 34 years old (medical history No. 1359), turned to the cardiac surgery department of the Regional Clinical Hospital named after NN Burdenko, Penza with complaints of compressive pain to the left of the sternum without a clear connection with physical exertion, shortness of breath with exertion of moderate intensity. Such complaints have been troubling for 2 years. He was observed in a district hospital with a diagnosis of coronary heart disease. Angina pectoris II functional class. The administration of nitrates did not bring the desired relief. The patient's father died suddenly at the age of 42. The patient does not smoke, leads a sedentary lifestyle, denies the presence of diabetes mellitus, arterial hypertension, myocardial infarction and strokes.

An objective study - blood pressure 110/65 mm Hg, heart rate 72 beats. per minute, heart sounds are muffled, rhythmic, splitting of II tone on the aorta, systolic murmur along the left edge of the sternum, carried out in the axillary region, amplified in the standing position and during the Valsalva test. The breathing is vesicular, no wheezing. The abdomen is soft, painless, the liver and spleen are not enlarged. An ECG at rest is a sinus rhythm, a deviation of the electrical axis of the heart to the left, signs of left ventricular myocardial hypertrophy, abnormal Q waves in leads V ₄ -V ₆ .

Triplex scanning of carotid arteries. The peak systolic velocity of the parietal blood flow was 80.7 cm / s, the central blood flow was 83.6 cm / s, the ratio of V _st / V _c 0.96. The complex of intima-media 0.9 mm., Stenosis of the carotid arteries were not detected.

Echocardiography revealed a thickening of the basal division of the interventricular septum and the anterior wall of the left ventricle up to 20 mm with a thickness of the posterior wall of the left ventricle of 9.6 mm. The maximum pressure gradient in the outflow tract of the left ventricle is 120 mm Hg. The final diastolic volume of the left ventricle is 102.8 ml. Dilatation of the left atrium. Hypertrophic diastolic dysfunction of the left ventricle.

Based on the results of the examination, it was concluded that the atherogenic nature of the disease was unlikely and the diagnosis was made:

Asymmetric hypertrophic cardiomyopathy with obstruction of the outflow tract of the left ventricle, CHF IIA, II FC.

However, the patient insisted on an additional examination - coronary angiography to exclude coronary artery disease. When coronary angiography was performed, no visible stenosis was detected; the type of blood circulation was right.

When duplex scanning of the arteries of the lower extremities, atherosclerotic lesions were also not detected.

At discharge, drugs for the treatment of heart failure were prescribed and a consultation in a clinic in Moscow for surgical treatment was recommended.

Example 3

Patient D-s, 43 years old (medical history No. 1428), was admitted to the cardiology department of the Regional Clinical Hospital. NN Burdenko, Penza, with complaints of heart palpitations, interruptions in the work of the heart, shortness of breath with a small load. From the anamnesis: the above complaints arose 2 weeks ago, such attacks are disturbed for 6 months no more than 1 time per month, stopped on their own. Smokes for at least 5 cigarettes a day for 20 years, leads a sedentary lifestyle, the patient's mother died at the age of 74 from myocardial infarction.

An objective study - blood pressure 130/70 mm Hg, heart rate 120 beats. per minute, heart sounds are muffled, arrhythmic, no noise. The vesicular breathing, no wheezing. The abdomen is soft, painless, the liver is not enlarged. ECG - atrial fibrillation, tachysystole.

With echocardiography: dilatation of the left atrium, mitral regurgitation of 2 degrees, the mass of the myocardium of the left ventricle and its contractility are normal, no violations of local contractility were found.

The patient underwent electrical defibrillation. Sinus rhythm restored.

Triplex scanning of carotid arteries. Peak systolic velocity of parietal blood flow was 65.2 cm / s, central blood flow - 93.2 cm / s., The ratio of V _st / V _c 0.70. Complex intima-media 0.9 mm, stenosis of the carotid arteries were not detected.

Duplex scanning of lower limb arteries. Stenosis of the left common femoral artery 21%.

Coronarography revealed stenosis in the middle part of the anterior interventricular artery up to 15%, the type of blood circulation is left.

Diagnosis: ischemic heart disease. Paroxysmal atrial fibrillation. Atherosclerotic cardiosclerosis, atherosclerosis of the arteries of the lower extremities. CHF II A, III FC.

At discharge, the patient was prescribed drugs to maintain sinus rhythm, recommendations were given for the prevention of the progression of atherosclerotic lesions, and repeated examination during the year.

Example 4

Patient A-s, 54 years old (outpatient card 97845362) went to the clinic of the Regional Clinical Hospital. NN Burdenko, Penza with complaints of headaches with increasing blood pressure. Arterial hypertension has been observed over the past 5 years, the maximum blood pressure of 218/110 mm Hg, working pressure of 180/100 mm Hg, is difficult to treat with antihypertensive drugs. He smokes for at least 7 cigarettes per day for 18 years, leads an active lifestyle, the patient's father suffered from a cardiovascular disease.

An objective examination - blood pressure 190/110 mm Hg, heart rate 79 beats per minute, heart sounds are muffled, rhythmic, no noise. The vesicular breathing, no wheezing. The abdomen is soft, painless. ECG - left ventricular hypertrophy.

Echocardiography: degenerative changes in the aortic wall, left ventricular hypertrophy, hypertrophic type of left ventricular dysfunction, left ventricular contractility is normal.

Triplex scanning of carotid arteries. Peak systolic velocity of parietal blood flow 82 cm / s, central blood flow - 102 cm / s., The ratio of V _st / V _c 0.80. Complex intima-media 0.9 mm, stenosis of the carotid arteries were not detected.

Duplex scanning of lower limb arteries. Blood flow of the main type, symmetrical on both lower extremities, of usual speed and spectral characteristics. No stenosis was detected.

X-ray contrast coronarography. Type of blood circulation - left. No stenosis was detected.

X-ray contrast aortography. Critical stenosis (78%) of the mouth of the right renal artery.

Duplex scanning of the abdominal aorta and renal arteries. The wall of the abdominal aorta is unevenly thickened, thickened. In the area of the mouth of the right renal artery, a hyperechoic atherosclerotic plaque is visualized, stenosing the lumen by 78%. Acceleration of blood flow to 314 cm / s is recorded above the plaque.

Diagnosis: Atherosclerosis of the abdominal aorta, renal arteries. Secondary vasorenal arterial hypertension. Risk IV.

The patient was referred to an angiosurgeon to resolve the issue of surgical treatment. He refused the proposed balloon angioplasty; he took the prescribed drugs of the statin group and antihypertensives irregularly.

A year later, a triplex scan of the carotid arteries revealed an increase in the intima-media complex to 1.1 mm, and differentiation into layers was impaired. Peak systolic blood flow velocity near the wall 76.5 cm / s, the central flow - 98.4 cm / s, the ratio V _v / V _i 0.77 stenosis is not revealed.

Diagnosis after a year: Atherosclerosis of the aorta, carotid arteries, renal arteries. Secondary vasorenal arterial hypertension. Risk IV.

Example 5

Patient K-va, 41 years old (medical history 1869) was hospitalized in the emergency surgery department of the Regional Clinical Hospital. NN Burdenko, Penza with complaints of acute pain in the upper right quadrant of the abdomen, in the epigastrium.

From the data of an objective examination: HELL 120/80 mm Hg, heart rate 89 beats per minute, heart sounds are clear, the rhythm is correct. The vesicular breathing, no wheezing. The abdomen is painful in the right hypochondrium, points of the gallbladder, a positive symptom of Murphy.

Ultrasound examination of the abdominal cavity. Gallbladder calculi. Signs of acute cholecystitis.

The patient underwent an operation of cholecystectomy.

Echocardiography, duplex scanning of lower limb arteries - no pathology was detected.

Triplex scanning of carotid arteries. Peak systolic velocity of parietal blood flow is 94.6 cm / s, central blood flow is 125.8 cm / s, the ratio of V _st / V _c 0.75. Complex intima-media 0.8 mm. Stenosis of the common carotid arteries was not detected. At the mouth of the left internal carotid artery, a semi-concentric, heterogeneous, with a predominance of hyperechoic component, with an even surface atherosclerotic plaque, stenosing the lumen by 38%, was visualized along the posterior medial wall for 12 mm. No hemodynamic shift in the stenosis area was recorded, and the speed and spectral characteristics were unremarkable.

Blood chemistry. Total cholesterol 6.2 mmol / L.

Diagnosis: Acute cholecystitis. Cholecystectomy Atherosclerosis of the carotid arteries. Stenosis of the left internal carotid artery 38%.

At discharge, in addition to recommendations for the underlying disease, the patient was recommended to take statin drugs and a triplex scan of the carotid arteries in dynamics once a year.

The patient did not take the prescribed drugs. After 10 months, a transient violation of cerebral circulation was confirmed, confirmed by a neurologist. When triplex scanning of the carotid arteries revealed: peak systolic velocity of parietal blood flow 64.5 cm / s, central blood flow - 87.5 cm / s, the ratio of V _st / V _C 0.73. Intima-media complex 1.0 mm. Stenosis of the common carotid arteries was not detected. At the mouth of the left internal carotid artery, a semiconcentric, heterogeneous, with an uneven, ulcerated surface atherosclerotic plaque was visualized along the posteromedial wall for 12 mm, stenosing the lumen by 59%. A 2-fold acceleration of blood flow was recorded over the plaque compared with the pre-stenotic section.

Diagnosis: Atherosclerosis of the carotid arteries. Stenosis of the left internal carotid artery 59%. Unstable plaque.

The patient is referred to an angiosurgeon to resolve the issue of surgical treatment.

According to the inventive method, 110 patients were examined (average age 51.3 ± 8.4 years). The study data are presented in table 2. The degree of arterial hypertension is given by the WHO classification of 1999, the functional class of heart failure and angina is classified by the New York Cardiology Association (NYHA).

An analysis of the data showed that groups of patients similar in age, gender, and central hemodynamic parameters, but different in magnitude of the ratio V _st / V _c , have an important difference - adherence to atherosclerosis.

Thus, it is obvious that the application of the proposed method in clinical practice will allow high-efficiency early diagnosis of atherosclerosis, which will help to identify a group of patients in need of treatment or prevention. The method is accessible for development, safe, fairly simple, can be used in medical institutions equipped with ultrasound devices with a pulse-wave Doppler mode. The implementation of the proposed method in practical medicine will provide rational management tactics for patients with atherosclerosis, which will lead to a decrease in mortality and disability.

table 2 Characteristics of the examined patients Indicator V _st / V _c More than 0.9 Less than 0.89 Number of patients fifty 60 Age years 47.2 ± 8.76 50.1 ± 7.74 Male / female ratio 29/21 32/28 Smokers 9 24 Atherosclerotic lesion of the carotid arteries, people 0 22 Atherosclerotic lesion of the arteries of the lower extremities, pers. 0 eighteen Atherosclerotic lesion of the branches of the abdominal aorta, pers. 0 2 Atherosclerotic lesion of the coronary arteries, pers. 0 28 Angina pectoris, FC 0.02 ± 0.001 2.8 ± 1.2 * Arterial hypertension, degree 0.1 ± 0.002 1.7 ± 0.8 * KhSP, FC 1.58 ± 0.8 2.5 ± 0.63 * Serum cholesterol, mmol / l 4.2 ± 0.4 5.7 ± 0.8 * Left ventricular ejection fraction,% 56.8 ± 10.5 50.8 ± 12.8 Stroke volume of the left ventricle, ml 73.2 ± 22.4 72.1 ± 20.5 Note: * - p <0.05.

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Claims (1)

A method for diagnosing the early stages of atherosclerosis, including ultrasound, characterized in that they perform a pulse-wave Doppler scan of the common carotid artery at a distance of 1 cm proximal to its bifurcation, determine peak systolic blood flow velocities directly at the wall (V _st ) and in the center of the vessel (V _c ), the ratio of V _st / V _{c is} calculated, at a value of which less than 0.89, atherosclerosis is diagnosed.

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