RU2532876C1 - Diagnostic technique for initial manifestations of systolic right ventricular dysfunction - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to ultrasonic diagnostic. A return signal velocity is measured in a normal Doppler pulse-wave mode at a level of a lateral edge of the tricuspid valve, and if sr is less than 14 cm/s, the systolic right ventricular dysfunction is diagnosed.

EFFECT: method enables assessing the systolic right ventricular dysfunction quantitatively that enables monitoring the values in the course of treatment; it possesses high accuracy and informative value by the fact that sr does not depend on the heart rate.

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Description

The present invention relates to medicine, namely to ultrasound diagnostics and cardiology, and can be used to diagnose systolic dysfunction of the right ventricle using pulse-wave Doppler ultrasound in patients with different cardiac pathologies.

The study of systolic function of the right ventricle (SF RV) is an urgent problem. Pancreatic function may worsen with primary and secondary pulmonary hypertension, including and acute (thromboembolism, bronchiectasis, etc.). With pancreatic infarction, myocarditis and pancreatic myocardiopathies, systolic function (pancreatic diabetes) needs to be evaluated, but, unfortunately, there are a number of limitations due to visualization difficulties. Although such modern research methods as angiography, radionuclide ventriculography, nuclear magnetic resonance and cardiac catheterization with hemodynamic measurements allow us to evaluate the structure and pump function of the pancreas [Oldershow P., Bishop A. The difficulties of assessing right ventricular function. Brit. Heart J. 1995; 74: 99-100], but due to invasiveness or high cost, they cannot be routinely used in a cardiology clinic.

A generally accessible method for non-invasive evaluation of the function of the right heart is echocardiography. Unfortunately, this method also has a number of technical limitations. First, the pancreas, unlike the left ventricle, has a more complex cavity configuration. The pancreatic cavity consists of the inlet and outlet sections, as well as the main chamber, curved in the shape of a crescent. The spatial model of the pancreas is a pyramid with a triangular base. It is difficult to describe using conventional mathematical approaches that cannot take into account the transverse expansion of the pancreas and its outflow tract. This limits the capabilities of a conventional two-dimensional echocardiography. Secondly, the information content of the study is largely determined by the quality of the apparatus and the sensor. This problem can be largely solved by using more advanced and sensitive equipment. Thirdly, in elderly patients, emphysema of the areas of the lungs adjacent to the heart is often observed, which limits the ultrasound window and access to the study. With a narrowing of the intercostal space, research is possible only with a strictly sagittal direction of the beam, since the slightest tilt of the sensor is accompanied by a rib entering the field of location.

One of the important issues related to medical diagnostic and preventive measures in cardiology is the early diagnosis of systolic and diastolic ventricular myocardial dysfunction. Severe systolic dysfunction of the right ventricle is quite easy to recognize. It is much more difficult to assess the borderline states and initial manifestations of systolic pancreatic dysfunction.

As a prototype, we have chosen a well-known method for diagnosing systolic dysfunction of the right ventricle by assessing the amplitude of the displacement of the right atrioventricular fibrous ring throughout the cardiac cycle.

According to this method, it is recommended to focus on changing the position of the right atrioventricular fibrous ring at the site of attachment of the anterior tricuspid valve leaflet. The displacement of this mobile region reflects the contraction of the longitudinal muscle fibers of the pancreas and corresponds to the movement of the base of the pancreas towards the apex. With a pronounced decrease in systolic function of the pancreas, the amplitude of the displacement of the tricuspid valve sharply decreases (see. "Clinical echocardiography". Shiller N., Osipov MA 2005, p. 106).

However, this method is uninformative and does not allow quantitative assessment of systolic dysfunction of the right ventricle.

The disadvantages of the prototype include the fact that: 1) in most patients it is not possible to clearly visualize the lateral edge of the tricuspid valve. The picture in the M mode is very blurry, and therefore it is not possible to unambiguously measure the amplitude of the displacement of this structure; 2) large variability of the standard values of the amplitude of the bias of the tricuspid valve.

In this regard, the problem of developing simple, affordable for practical health care, but effective Doppler echocardiographic diagnostic methods that accurately diagnose a violation of systolic function of the myocardium of the right ventricle, remains an urgent problem.

The technical result of the invention is affordable, accurate, informative, applicable for patients of different ages, echocardiographic diagnosis of systolic dysfunction of the myocardium of the right ventricle, as well as reducing the time of the study.

The problem is achieved in that a method for diagnosing the initial manifestations of systolic dysfunction of the right ventricle involves measuring, in the usual Doppler pulse-wave mode, velocity indicators of the movement of the fibrous ring of the atrioventricular valve.

In accordance with the invention, the speed indicator of the echo signal is measured at the level of the lateral edge of the tricuspid valve, and with sr less than 14 cm / s, systolic dysfunction of the right ventricle is diagnosed.

Compared with the prototype of the inventive method has the following advantages: the method is simple and easy to reproduce, does not require additional expensive equipment and software, which significantly reduces the research time. In addition, there is no need to use different types of loads and conduct functional tests; the sr indicator does not depend on the heart rate (HR). The accuracy of determining indicators is significantly higher than that of the prototype.

The proposed method is illustrated in figure 1.

The figure 1 shows: left: a diagram of the position of the sensor and the placement of the control volume for recording a pulse wave spectrogram from the tricuspid valve ring; right: recorded Dopplerogram (sr - systolic component, er and ar - early and late diastolic components).

The method is as follows: during echocardiography, an image is obtained from the apical 4-chamber position of the heart, a control volume of 0.2 cm is set at the level of the lateral edge of the tricuspid valve (Fig. 1).

At a minimum level of the echo filter, a spectrogram recorded by a conventional pulse-wave Doppler is obtained, the speed indicators of Doppler signals are measured - sr, ar and er (where sr is the echo signal above the isoline, corresponds to the systole of the right ventricle, er and ar are echo signals below the contours that correspond to the early and late diastolic components) and with an sr value of less than 14 cm / s, the presence of systolic dysfunction of the right ventricle is diagnosed.

The proposed method examined 55 people, including 19 healthy patients and 37 with various cardiac pathologies, aged 26 to 88 years (average age was 53 ± 15.7 years); 32 of them are women. In all recorded cases, the pulse-wave spectrogram was clear, and speed parameters can be measured easily. Visually, the curves of a conventional pulsed-wave Doppler were clear, the velocity peaks of the systolic and diastolic components of a conventional pulsed-wave Doppler showed the following values: sr = 17.3 ± 3.0 cm / s; er = 17.7 ± 4.6 cm /; ar = 16.3 ± 3.8 cm / s.

Clinical example. Patient A., 59 years old, was admitted with a diagnosis of post-infarction cardiosclerosis, the state after shunting, arterial hypertension, 3 stages, 2 degrees. NK I. Complaints of pain in the heart, shortness of breath at rest, swelling of the lower extremities. An ultrasound revealed: aortic sclerosis. Condition after coronary artery bypass grafting. Scar of the anterior wall of the left ventricle with transition to the interventricular septum and apex. Decreased LV ejection fraction to 39%. Slight relative mitral valve insufficiency. Expansion of the left atrium. Increased pressure in the pulmonary artery.

When measuring the speed parameters of the echo signals, it was established: the value of sr corresponds to a level of 12 cm / s, i.e. less than the boundary value of 14 cm / s. According to the proposed method, it was possible to identify the initial manifestations of systolic dysfunction of the right ventricle.

Additionally diagnosed: diastolic dysfunction of the left ventricle of the second type. Diastolic dysfunction of the right ventricle of the first type.

Thus, the claimed method has the following advantages:

1) allows you to evaluate not only systolic, but also diastolic function, which expands the diagnostic possibilities when using this method, since systolic and / or diastolic dysfunction of the right ventricle appears not only in IHD, but also in other diseases of the cardiovascular system (arterial hypertension , cardiomyopathies, myocarditis, etc.), i.e. the method is versatile;

2) makes it possible to quantify systolic and diastolic dysfunction of the right ventricle, which allows monitoring of indicators during treatment;

3) the method does not require physical activity, which expands the contingent of the subjects and significantly reduces the study time;

4) the method has high accuracy and informativeness, as evidenced by the criteria of sensitivity and specificity. The sensitivity (H) and specificity (C) of the sr indicator in the separation of individuals with _{pancreatic diabetes} and without _{pancreatic fibrosis} with an MIC of ≤14 cm / s were 100.0% and 81.6%, respectively;

5) the method is simple and easily reproducible even in patients who are difficult to visualize, since it does not require a clear visualization of the heart structures.

Claims (1)

A method for diagnosing the initial manifestations of systolic dysfunction of the right ventricle by measuring in Doppler pulse-wave mode the velocity indicators of the fibrous ring of the atrioventricular valve, characterized in that they measure the velocity of the echo signal at the level of the lateral edge of the tricuspid valve and diagnose when sr is less than 14 cm / s systolic dysfunction of the right ventricle.