RU2373542C1 - Method for prediction of development of myocardial infarction complication - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, particularly cardiology and can be used to predict complications of myocardial infarction including in the middle-age patients at the hospital rehabilitation stage. To implement the method, blood serum is analysed for glycosaminoglycan (GAG) count; common (OP_com) and peptide-fixed (OP_pept) oxyproline is analysed in urine singly for each of two phases reparative fibrosis, corresponding to 1-3 days (destruction phase), to 10-12 days (phase of maximum synthesis of territorial matrix proteins). If the relations GAG₁<GAG₂; OP_com1<OP_com2; OP_pept1<OP_pept2 are observed, favourable prognosis of clinical course is given, while the relations GAG₁> GAG₂; OP_com1> OP_com2; OP_pept1> OP_pept2 show unfavourable prognosis.

EFFECT: application of the invention allows simplifying prediction of development of myocardial infarction complications.

1 tbl, 4 ex

Description

The invention relates to medicine, in particular cardiology, and can be used to predict complications of myocardial infarction, including in persons of older age groups at the stage of hospital rehabilitation.

Hospital mortality in myocardial infarction increases significantly with the development of complications of the disease, especially in older age groups of patients. On average, it is 14.7%, including 4.9% in the group of patients aged 45-59 years old, 13% 60-74 years old, 21.1% 75 years old and older [1]. It is known that with ischemia and myocardial necrosis, the scarring process begins already from 2 days with the mandatory participation of the main extracellular matrix proteins, which actually make up the scar tissue. If the process of post-infarction reparative fibrosis is disturbed in time (deceleration, acceleration) and in the quality of the formed scar tissue (changing the ratio of the main components of scar tissue), early and late complications of myocardial infarction (heart aneurysm, cardiogenic shock, acute heart failure, heart rhythm disturbance) develop, requiring additional therapeutic measures. Timely prediction of the development of complications of myocardial infarction is extremely important to prevent death.

A known method for predicting the complications of myocardial infarction, including fixing the time from the onset of pain associated with this disease to the start of thrombolytic therapy, conducting echocardiography on the second day with determining the average pressure in the pulmonary artery, measuring the maximum speed of late diastolic filling of the right and left ventricle and diameter left atrium, measurement of heart rate at rest on the 12-14th day of the disease; using special mathematical formulas determine prognostic coefficients K1, K2, K3, corresponding to I, II, and III functional classes of heart failure according to NYHA classification, then select the coefficient with the highest absolute value and predict the patient’s condition on the 30th day of the disease in accordance with with a functional class of heart failure according to NYHA classification, to which this coefficient belongs [2]. The disadvantage of this method is that it does not allow to predict the development of other types of complications, namely: aneurysm of the heart, cardiogenic shock, heart rhythm disturbance.

A known method for predicting the complications of myocardial infarction, including the determination of clinical, laboratory, electrocardiographic indicators of the condition and risk factors for myocardial infarction from the patient’s history: gender, age, history of heart attack, diabetes mellitus, signs of heart failure upon admission, relief of pain at the prehospital stage, dispersion QT interval, white blood cell count, erythrocyte sedimentation rate, blood sugar, establishment of their gradations and numerical values, determination e prognostic factors F ₁ and F ₂ according to the formulas followed by a comparison of their values, characterized in that on the first day of the patient’s stay in the hospital, they additionally determine the nature of the heart attack by ECG signs of necrosis, primary or repeated heart attack by history, recurrence of pain in 1 e day of hospital stay, ECG signs of left ventricular hypertrophy, heart rate per minute upon admission, life-threatening ventricular arrhythmias, atrial fibrillation, atrioventricular block, chronic I circulatory failure, recurrent or without recurrence of a heart attack, and prognostic factors F ₁ and F ₂ determined by the given formulas:

F ₁ = -45.59 + 1.32x ₁ + 0.42x ₂ + 9.72x ₃ + 2.04x ₄ + 0.91x ₅ -0.72x ₆ + 1.76x ₇ -0.25x ₈ -1, 13x ₉ -0.65x ₁₀ + 0.16x ₁₁ + 0.17x ₁₂ + 0.9x ₁₃ -0.09x ₁₄ + 0.21x ₁₅ + 3.17x ₁₆ -3.13x ₁₇ + 2.03x ₁₈ +0, 64x ₁₉ + 8.03x ₂₀ ;

F ₂ = -60.80 + 1.77x ₁ + 0.46x ₂ + 8.85x ₃ + 2.61x ₄ + 0.96x ₅ -0.41x ₆ + 2.86x ₇ -0.49x ₈ -0, 86x ₉ -0.32 x ₁₀ + 0.21x ₁₁ + 0.18x ₁₂ + 1.03x ₁₃ -0.07x ₁₄ + 0.26x ₁₅ + 3.91x ₁₆ -3.47x ₁₇ + 2.54x ₁₈ +1, 78h 8,68h ₁₉ + _20, respectively,

where x _{1,2 ... 20} - gradations and numerical values of risk factors, and

x ₁ - gender: male -1 female - 2;

x ₂ is the number of full years;

x ₃ - the nature of the heart attack by ECG signs of necrosis: transmural - 1, large focal - 2, heart attack without Q - 3;

x ₄ - primary or repeated heart attack: primary - 1, repeated - 2;

x ₅ - history of heart attack: without complaints from the cardiovascular system - 1, history of heart attack without angina pectoris - 2, stable angina pectoris - 3; first arising angina pectoris - 4; shortness of breath or other signs of circulatory disorders - 5;

x ₆ - diabetes mellitus: no - 0, eat - 1;

x ₇ - signs of heart failure according to Killip upon admission: no - 1, congestion in the pulmonary circulation - 2, pulmonary edema - 3, cardiogenic shock - 4;

x ₈ - relief of a pain attack at the prehospital stage: effective - 1, ineffective - 2;

x ₉ - recurrence of pain in the hospital: yes - 1, no - 2;

x ₁₀ - ECG signs of left heart hypertrophy: none - 0, signs of left ventricular hypertrophy - 1, signs of left atrial hypertrophy - 2;

x ₁₁ is the variance of the QT interval, ms;

x ₁₂ - the number of heartbeats per minute;

x ₁₃ - the number of white blood cells;

x ₁₄ - erythrocyte sedimentation rate, mm / h;

x ₁₅ - blood sugar, mmol / l;

x ₁₆ - life-threatening ventricular arrhythmias: no - 0, ventricular paroxysmal tachycardia - 1, ventricular fibrillation - 2;

x ₁₇ - atrial fibrillation: no - 0, paroxysm - 1, permanent form - 3;

x ₁₈ - atrioventricular block: no - 0, I degree -1, II degree - 2, full III degree - 3;

x ₁₉ - chronic circulatory failure: no - 0, stage II - 1, stage IIA - 2, stage IB - 3, stage III - 4;

x ₂₀ - course of a heart attack: without relapse -1, recurrent - 2;

and at F ₁ greater than or equal to F ₂ , a conclusion is made about a favorable prognosis of the course of the disease, and at F ₂ greater than F ₁ , an unfavorable prognosis of the outcome of myocardial infarction with the development of complications [3]. The disadvantage of this method is its complexity and the complexity of calculating prognostic criteria. In addition, it does not allow prediction of certain types of complications of myocardial infarction.

A known method for predicting the complications of myocardial infarction, including conducting an electrocardiographic study, monitoring the heart rate, determining the amount of urine output, systolic blood pressure, objective examination of a patient admitted to the intensive care unit, determination of the effective concentration of albumin in the patient's blood serum; at its values of 30-35 g / l, the development of cardiogenic shock with a favorable outcome is predicted, and at values of 29 g / l and below, an unfavorable course of cardiogenic shock is predicted [4]. The disadvantage of this method is that it does not allow to predict the development of aneurysm of the heart, acute heart failure, cardiac arrhythmias. In addition, the method allows not only to predict the development of cardiogenic shock, but to identify its beginning, the signs of which are systolic blood pressure of 80 mm Hg or less; pulse pressure 20 mmHg and below; oliguria or anuria (diuresis less than 20 ml / h); peripheral signs of impaired microcirculation; impaired consciousness (inhibition up to a stop or psychomotor agitation in combination with disorientation).

A known method for predicting the development of critical conditions associated with the syndrome of systemic inflammatory reaction, which in terms of myocardial infarction, includes the determination in the patient's plasma of myoglobin content as an early marker of myocardial necrosis; when the myoglobin index is above 800 ng / ml, a conclusion is made about an unfavorable prognosis of the development of the disease [5]. The disadvantage of this method is that it predicts the development of complications in the development of large focal myocardial necrosis and does not allow a differentiated prognosis of complications in other clinical forms of the disease. In addition, the content of myoglobin is a non-specific indicator for myocardial infarction and can also change with necrotic lesions of other organs and tissues, as well as with impaired renal function.

A known method for early prediction of malignant ventricular arrhythmias as a type of complication of myocardial infarction, including the study of electrocardiographic indicators of late ventricular potentials by signal-averaged electrocardiography, standard deviation of the values of RR intervals during the day, dispersion of QT intervals, left ventricular ejection fraction, and personal anxiety, study of indicators of late ventricular potentials (PCa) by the method of signal-averaged ECG and p and the presence of any two of the three criteria for the presence of prostate cancer in the subacute stage of myocardial infarction, detecting a combination of the standard deviation of the values of the RR intervals during the day less than 70 ms, the ejection fraction of the left ventricle less than 40%, the variance of the QT intervals more than 60 ms and a high personal anxiety rate predict the development of malignant ventricular arrhythmias in the period of post-infarction cardiosclerosis [6]. The disadvantage of this method is that it does not allow to predict the development of aneurysm of the heart, acute heart failure, cardiogenic shock.

A known method for predicting the complications of myocardial infarction, including conducting a clinical examination, electrocardiography on the background of stress tests; in the presence of severe systolic dysfunction of the left ventricle, early post-infarction angina pectoris, ventricular arrhythmias of high gradations, as well as signs of ischemia during a stress test, the risk of an adverse course of the disease is determined according to special scales [7]. The disadvantage of this method is that the criteria selected for predicting the complications of myocardial infarction actually reflect the onset of complications and do not allow predicting their development at earlier stages.

A known method for predicting the complications of myocardial infarction, including determining the age of the patient, the mass of necrosis, daily determination of the concentration of hypochlorous mucoprotein, glycosaminoglycans in the blood and urine of the patient for 14 days from the onset of the disease, determining the rate of increase of these indicators per day according to the formula V _ij = Н _{ij + 1-} H _ij , where V _ij is the rate of change of inflammatory markers on day j in i patient; H _{ij + 1} and H _ij - the content of these markers in i patient on day j and day j + 1; determination of the value of the indicator F by the formula: F = 0.02Mn + 0.06P + 0.02 V _HMP + 40.09V _{GAG blood} + 0.006V _GAG mochi -7.15, where Mn is the mass of necrosis; P is age; V _CMP , V _{GAG blood} , V _{GAG mochi} - the maximum rate of increase in the concentration of hypochlorous mucoprotein (CMP), glycosaminoglycans (GAG) in blood and urine: a conclusion about a favorable outcome of myocardial infarction at F <0 and about possible complications of myocardial infarction at F> 0 [8 ]. The sensitivity of the proposed model is 80%, specificity is 100%, the value of negative prediction is 100%, and positive prediction is 83%. The method can be used when choosing treatment tactics and rehabilitation measures both in the nosocomial period and during the observation of the patient in the clinic. The disadvantage of this method is the complex calculation of indicators, the need for daily blood and urine sampling to determine the parameters of a particular patient within 14 days of hospital stay, the lack of criteria for differential diagnosis of disease complications.

The problem to which the invention is directed, is to simplify the method, reducing the number of measurements.

The solution of this problem is achieved by the additional determination of the content of fibronectin (FN) in blood serum, total (OD _total ) and peptide-bound (OD _pept ) _oxyproline in urine, the determination is carried out once on each of the two phases of reparative fibrosis, corresponding to 1-3 -th days (phase of destruction) and 10-12th days (phase of maximum synthesis of extracellular matrix proteins) from the onset of the disease; at ratios of quantities

GAG ₁ <GAG ₂ ; OP _common1 <OP _common2 ; OD _pept1 <OD _pept2 ; FN ₁ <FN ₂ no less than 1.2 times make a conclusion about a favorable prognosis of the course of the disease; with GAG ₁ > GAG ₂ ; OP _common1 > OP _common2 ; OD _pept1 > OD _pept2 ; FN ₁ <FN ₂ not less than 1.5 times - about an unfavorable prognosis; with an unfavorable prognosis, the possible type of complications of the disease is determined:

with GAG ₁ > GAG ₂ 2.7 times or more; OP _common1 > OP _common2 1.6 times or more;

OD _pept1 > OD _pept2 1.1 times or more; FH ₁ <FN ₂ not less than 2 times; make a conclusion about the possible development of aneurysm of the heart;

with GAG ₁ > GAG ₂ in 1.35 or more times; FH ₁ <FN ₂ not less than 1.2 times;

OP _common1 > OP _common2 1.4 times or more;

OD _pept1 > OD _pept2 1.3 times or more - about the development of acute heart failure;

with GAG ₁ > GAG ₂ in 2 or more times; OP _common1 > OP _common2 1.6 times or more;

OD _pept1 > OD _pept2 1.37 or more times; FH ₁ <FH ₂ not less than 1.27 times - on the development of cardiogenic shock;

with GAG ₁ > GAG ₂ in 1.2 or more times; OP _common1 > OP _common2 1.4 times or more;

OD _pept1 > OD _pept2 1.3 times or more; FH ₁ <FN ₂ not less than 1.47 times - about the possible development of cardiac arrhythmias.

Description of the invention

A method for predicting the complications of myocardial infarction is as follows. In patients with acute myocardial infarction, blood and urine are sampled in the morning on an empty stomach in one of the days of the first two phases of reparative fibrosis: the destruction phase (1-3 days from the onset of the disease), the phases of the maximum synthesis of extracellular matrix proteins (10-12 days from the onset of the disease). The characteristics of the phases of reparative fibrosis are presented in [9]. Determine the content of glycosaminoglycans (GAG) and fibronectin (FN) in the blood serum, the content of peptide-bound (OD _pept ) and total (OD _total ) oxyproline in the urine, while the content of total oxyproline is determined as the sum of free and peptide-bound oxyproline in the urine.

The content of fibronectin is determined by enzyme-linked immunosorbent assay (according to the instructions for use of the IMTEK test system, Moscow) [10], glycosaminoglycans - by the orcin method [11]. Total, free and peptide-bound hydroxyproline in the urine is determined using paradimethylaminobenzaldehyde [12]. For each parameter, its values are compared on two phases of reparative fibrosis and the following conclusion is made:

additionally determine the content of fibronectin (FN) in blood serum, total (OD _total ) and peptide-bound (OD _pept ) _oxyproline in the urine, the determination is carried out once on each of the two phases of reparative fibrosis, corresponding to 1-3 days (phase of destruction) and 10-12 days (phase of maximum synthesis of extracellular matrix proteins) from the onset of the disease;

when the ratio of the GAG ₁ <GAG ₂ ; OP _common1 <OP _common2 ; OD _pept1 <OD _pept2 , FN ₁ <FN ₂ at least 1.2 times make a conclusion about a favorable prognosis of the course of the disease; with GAG ₁ > GAG ₂ ; OP _common1 > OP _common2 ; OD _pept1 > OD _pept2 ; FN ₁ <FN ₂ not less than 1.5 times - about an unfavorable prognosis.

In the presence of an unfavorable prognosis, the possible type of complications of the disease is determined:

with GAG ₁ > GAG ₂ 2.7 times or more;

OP _common1 > OP _common2 1.6 times or more; OD _pept1 > OD _pept2 1.1 times or more; FN ₁ <FN ₂ not less than 2 times; make a conclusion about the possible development of aneurysm of the heart;

with GAG ₁ > GAG ₂ in 1.35 or more times; FN ₁ <FN ₂ not less than 1.2 times;

OP _common1 > OP _common2 1.4 times or more; OD _pept1 > OD _pept2 1.3 times or more - about the development of acute heart failure;

with GAG ₁ > GAG ₂ in 2 or more times; OP _common1 > OP _common2 1.6 times or more; OD _pept1 > OD _pept2 1.37 or more times; FN ₁ <FN ₂ not less than 1.27 times - on the development of cardiogenic shock;

with GAG ₁ > GAG ₂ in 1.2 or more times; OP _common1 > OP _common2 1.4 times or more;

OD _pept1 > OD _pept2 1.3 times or more; FN ₁ <FN ₂ not less than 1.47 times - about the possible development of cardiac arrhythmias.

Case Studies

84 patients hospitalized on the first day of the disease with myocardial infarction were examined. According to the claimed method, in patients once on each of the two phases of reparative fibrosis corresponding to 1-3 days (phase of destruction), 10-12 days (phase of maximum synthesis of extracellular matrix proteins) from the onset of the disease, the content of glycosaminoglycans (GAG) was determined in serum, total (OD _total ) and peptide-bound (OD _pept ) _oxyproline in the urine. At the same time, patients underwent a traditional examination to diagnose possible complications of myocardial infarction, after which the patients were divided into 2 groups: a group without complications of myocardial infarction (7 people) and a group with complications (77 people). Depending on the type of complications, the second group was further divided into 4 groups corresponding to each type of complications.

The table shows the dynamics of changes in the content of glycosaminoglycans (GAG) in blood serum, total (OD _total ) and peptide-bound (OD _pept ) hydroxyproline in the urine in two studied groups of patients: in the group of patients in whom the disease passed without complications, and in the group patients who subsequently developed treatment complications of myocardial infarction, depending on the development of replacement reparative fibrosis: acute heart failure, cardiogenic shock, cardiac aneurysm, rhythm disturbance. Diagnosis was carried out by traditional methods. As can be seen from the table, the analyzed groups of patients with a favorable and unfavorable outcome of the disease differ among themselves in the ratio of the content of GAG in blood serum, _total OD and _{total peptides} in urine, i.e. according to the indicators that were determined in their early stages of the disease (in the first two phases of reparative fibrosis) before the development of complications.

The ratio of the values of these parameters in groups of patients without complications meets the criteria GAG ₁ <GAG ₂ ; OP _common1 <OP _common2 ; OD _pept1 <OD _pept2 .

In groups of patients with a disease complication (poor prognosis) - GAG ₁ > GAG ₂ ; OP _common1 > OP _common2 ; OD _pept1 > OD _pept2 .

The table also shows the GAG values in blood serum, _total OD and _{total peptides} in the urine of patients in the early stages of the disease who subsequently developed certain types of complications. The presented data meet the criteria for predicting complications described in the description of the invention.

The following are examples of predicting various types of complications in individual patients with myocardial infarction.

Example 1. Patient S., 50 years old, transmural anterior myocardial infarction, smokes. Upon receipt of ACT - 801 units / l, ALT - 1095, LDH - 1287, KFK - 3353, MV-KFK - 544.8, troponin 180. Blood and urine were taken from the patient on the first and tenth day of the disease and the GAG content was determined in blood serum, OD _total and OD _pept in urine according to the claimed method. The following results are obtained.

GAG ₁ - 5.8 mmol / L; GAG ₂ - 2.1 mmol / L;

OD _total1 - 44 μg / ml; OD _total2 - 27 μg / ml;

OD _pept1 - 19 μg / ml; OD _pept2 - 16 μg / ml.

The conclusion is made about an unfavorable prognosis of the course of the disease.

On the 21st day from the onset of the disease, according to the echocardiogram, it was found that the patient has a left ventricle moderately dilated, a sigmoid interventricular septum, a left ventricular aneurysm at the apex, and global left ventricular myocardial contractility is reduced. X-ray revealed an increase in the left heart, an increase in pulmonary pattern. Diagnosed with aneurysm of the left ventricle of apical localization. An unfavorable prognosis of the course of myocardial infarction according to the claimed method was justified.

Example 2. Patient P., 46 years old, large focal myocardial infarction of the lower wall, smokes, hypercholesterolemia (7.7 mmol / l). Upon receipt of LDH - 473 U / l, KFK - 333, MV-KFK - 95.5, troponin 7.5. Blood and urine were taken from the patient on the 2nd and 12th day of the disease and the content of GAG in blood serum, OD _total and OP _pept in urine were determined according to the claimed method. The following results are obtained.

GAG ₁ - 3.70 mmol / L; GAG ₂ - 2.72 mmol / L;

OD _total1 - 30.5 μg / ml; OD _total2 - 20.3 μg / ml;

OD _pept1 - 23.2 μg / ml; OD _pept2 - 16.6 μg / ml;

The conclusion is made about an unfavorable prognosis of the course of the disease.

On the 18th day after the onset of the disease, the patient observed cyanosis, tachypus, hard breathing, congestion in the pulmonary circulation, moist rales, and a decrease in EF of less than 40%. Radiologically determined: increased pulmonary pattern, the borders of the heart are shifted to the left. According to the echocardiogram revealed diastolic dysfunction, PV - 34%. Complaints of a feeling of heaviness in the precardial region, shortness of breath. Diagnosed with acute heart failure. The unfavorable prognosis of complication according to the claimed method was justified.

Example 3. Patient B., 47 years old, large focal myocardial infarction of the lower wall with the involvement of the right ventricle, in the history of life - urolithiasis, smokes. Upon receipt of LDH - 594 U / l, KFK - 274, MV-KFK - 24.6. The patient received blood and urine samples on the 1st and 11th day of the disease and determined the GAG content in the blood serum, the OD _total and the OP _pept in the urine according to the claimed method. The following results are obtained.

GAG ₁ - 5.6 mmol / L; GAG ₂ - 2.6 mmol / L;

OD _total1 - 33.0 μg / ml; OD _total2 - 19.2 μg / ml;

OD _pept1 - 18.7 μg / ml; OD _pept2 - 13.5 μg / ml.

The conclusion is made about an unfavorable prognosis of the course of the disease. On the 14th day, the patient complained of weakness, cold sweat, shortness of breath. On the basis of echocardiography, diastolic dysfunction of the left ventricle of the heart, hypoakinesis of the lower front wall with the transition to the right ventricle were established.

X-ray revealed enhanced enriched vascular pattern. Systolic blood pressure decreased to 85 mm Hg; oligonuria - 19 ml / h; metabolic acidosis - 7.1. Diagnosed with cardiogenic shock. The unfavorable forecast according to the claimed method was justified.

Example 4. Patient T., 47 years old, large focal myocardial infarction of the lower wall associated with arterial hypertension, a history of life - gastric ulcer, smokes. Upon receipt of AST-163.3 U / L, LDH - 861, KFK-1462, MV-KFK - 177. Blood and urine were taken from the patient on the 1st and 11th day of the disease and the content of GAG in the blood serum was determined, OP _total and OP _pept in urine according to the claimed method. The following results are obtained.

GAG ₁ - 4.9 mmol / L; GAG ₂ - 3.7 mmol / L;

OD _{total1 -} 28.1 μg / ml; OD _total2 - 18.6 μg / ml;

OD _pept1 - 17.9 μg / ml; OD _pept2 - 12.7 μg / ml;

The conclusion is made about an unfavorable prognosis of the course of the disease.

On the 20th day of the disease, according to the ECG, the patient had ventricular extrasystole. Diagnosed with heart rhythm disturbance. The forecast according to the claimed method was justified.

When using the claimed method, the number of blood and urine samples from the patient is reduced from 14 to 2 times, the number of determined parameters and indicators is reduced from 6 to 3, the volume of calculations for each of them (2 instead of 14 times for each parameter). In addition, the markers of necrosis used in the prototype (mass of necrosis and the concentration of hypochlorous mucoprotein in blood and urine), reflecting the vastness of the focus of necrosis, do not allow to determine the activity of the process of reparative fibrosis, on which the restoration of cardiac functions depends, and the determination of glycosaminoglycan is insufficient to conclude the successful course of reparative fibrosis, which limits the prognostic capabilities of the prototype method. Reducing the total number of defined parameters, an additional determination of the content of two forms of hydroxyproline in the claimed technical solution allows to increase the accuracy of predicting the complications of myocardial infarction, as well as reduce the complexity of the method.

Information sources

1. Pankin O.A. Pre-hospital factors of hospital mortality in myocardial infarction // Clinical medicine. - 2004. - No. 4. - S.36-40.

2. Patent for the invention of the Russian Federation No. 2273450 "A method for predicting the patient's condition after suffering an acute myocardial infarction", date publ. 2006.04.10, IPC А61В 5/02, А61В 8/00, А61В 8/02, А61В 8/04.

3. Patent for the invention of the Russian Federation No. 2276573 "Method for predicting the outcome of myocardial infarction", date publ. 2006.05.20, IPC ⁶ А61В 5/00, А61В 5/02.

4. Patent for the invention of the Russian Federation No. 2258226 "A method for predicting the development of cardiogenic shock in patients with acute myocardial infarction", date publ. 2005.08.10, IPC ⁷ G01N 33/68.

5. Patent for the invention of the Russian Federation No. 2293333 "Method for monitoring the development of critical conditions associated with the syndrome of systemic inflammatory reaction", date publ. 2007.02.10. IPC G01N 33/68.

6. Patent for the invention of the Russian Federation No. 2266042 "Method for early prediction of the occurrence of malignant ventricular arrhythmias in the period of post-infarction cardiosclerosis", date publ. 2005.12.20. IPC ⁷ А61В 5/0452, АВВ 5/02.

7. Sabatini M.S., O'Gara P.T., Lilly L.S. Acute myocardial infarction // In the book: Pathophysiology of diseases of the cardiovascular system / Ed. L. Lily, per. with eng. - M .: Binom, 2003. S.199-234.

8. Vinogradov A.V., Zhuravleva I.A., Voevodina N.Yu. et al. Prediction of the course of myocardial infarction by biochemical markers // Cardiology. 1999. No. 2. S.39-40.

9. Kim LB and other Post-infarction remodeling and phases of reparative fibrosis // Bulletin of NSU. - 2005.V.3. Issue 3. S.53-63.

10. Instructions for the use of a test system for determining human fibronectin by ELISA (IMTEK, Moscow) - 2006. - 2 p.

(http://www.imtek.ru/index.php?lnk=search&&resid=2&bkid=MHAFAPK4HDCDSSH&cat2=256&fres=358&dres=23&st=350).

11. Klyatskin S.A., Lifshits R.I. Determination of glycosaminoglycans by the orcine method in the blood of patients // Lab. a business. 1989. No. 10. S.51-53.

12. Sharaev P.N., Botnikova E.A., Ivanov V.M. et al. Determination of free and bound hydroxyproline in urine // Lab. a business. 1990. No. 12. S.23-25.

Table.
Dynamics of changes in the markers of reparative fibrosis in patients with myocardial infarction with complications and without complications Markers Unit. Phases of reparative fibrosis * one 2 x ± s _x ** x ± s _x ** Myocardial infarction without complications (n = 7) Serum glycosaminoglycans mmol / l 3.6 ± 1.4 3.9 ± 1.0 Oxyproline in urine mcg / ml 25.9 ± 6.8 29.9 ± 9.3 Oxyproline peptide-bound in urine mcg / ml 15.9 ± 4.9 22.7 ± 7.5 Myocardial infarction with complications (without division into types of complications) Serum glycosaminoglycans mmol / l 5.45 ± 0.4 3.15 ± 0.5 Oxyproline in urine mcg / ml 39.4 ± 3.1 25.65 ± 2.5 Oxyproline peptide-bound mcg / ml 22.8 ± 2.1 18.12 ± 1.9 Note: * 1 - phase of destruction (1-3 days from the onset of the disease), 2 - phase of maximum protein synthesis of the extracellular matrix (10-12 days from the onset of the disease). ** - x is the average value of the indicated sign in the group of examined, s _x is the error of the mean; the actual scatter of the values of the sign in the group can be wider than the indicated intervals, for the implementation of the method, the degree of increase or decrease in the value of the sign in an individual patient at the second stage of the disease (2) in comparison with the first stage (1)

Claims (1)

A method for predicting the complications of myocardial infarction, including determining the content of glycosaminoglycans (GAG) in blood serum, characterized in that it additionally determines the total (OD _total ) and peptide-bound (OD _peptide ) _oxyproline in the urine, the determination is carried out once on each of the two phases of reparative fibrosis corresponding to 1-3 days (phase of destruction) and 10-12 days (phase of maximum synthesis of extracellular matrix proteins) from the onset of the disease; at ratios of quantities
GAG ₁ > GAG ₂ ; OP _common1 <OP _common2 ; OD _pept1 <OD _pept2 conclude that the prognosis of the disease is favorable; with GAG ₁ > GAG ₂ ; OP _common1 > OP _common2 ; OD _pept1 > OD _pept2 - poor prognosis.