UA111185U - METHOD OF ASSESSMENT OF HEART FUNCTIONAL CONDITION ON THE BASIS OF ELECTROCARDIOGRAPHY ANALYSIS - Google Patents

Abstract

The method of assessing the functional state of the heart based on the analysis of the electrocardiogram, in which the examined patient is recorded using the cardiograph electrocardiogram (ECG), determine by hardware and software the actual heart rate (HR) and the actual values of the amplitude-time parameters of the cardiology, cardiac actual RR, QT, and PQ intervals for the actual heart rate determine the values of the proper Q-Tc and P-Qc intervals, evaluate the functional state of the AV connection by the deviation of the fac of the proper P-Q interval from the value of the proper P-Qc interval.

Description

The useful model belongs to medicine, in particular to the methods of assessing the functional state of the heart based on the analysis of the electrocardiogram (ECG) according to the proper P-o interval, corrected for heart rate (HR), and can be used in cardiology, pediatrics, functional diagnostics, sports medicine and under medical supervision for early diagnosis and prevention of the development of AM joint pathology in adults and children of all age groups.

One of the urgent tasks in cardiology is the early detection of initial forms of violations in the work of the AM junction in a healthy heart, since somatic pathology of the heart is characterized, as a rule, by a long period of the preclinical stage of its formation. At present, the evaluation of the work of the AM connection is carried out on the basis of the results of the ECG analysis on the duration of the P-O interval and is guided by the general norm from 120 ms to 200 ms without taking into account the relationship with the actual

heart rate At the same time, indicators outside this range are considered manifestations of cardiac activity disorders. The use of such a wide range of the general norm for the P-O interval, which reflects the electrical systole of the atria, practically excludes the possibility of diagnosing the initial stages of the development of AM junction pathology. However, for an objective assessment of the interval

O-T, which reflects the electrical systole of the ventricles, currently uses a corrected (corrected for heart rate) proper interval O-T (0-Ts), which is determined by Bazett's formula.

However, the time of the total systole of the heart consists of the time of ventricular systole and atrial systole with a pause in between. Based on the physiology of heart contraction, the use of a similar methodological approach, which takes into account the heart rate correction, is also appropriate for the objective assessment of the P-O interval. It is known that the P-O interval is not formed by two processes - contraction of the atria (P wave) and the conduction time of the impulse to the ventricles (P-O segment), but one process - the conduction of the impulse from the sinus node to the AM node and then to the ventricles. This single process is superimposed on the phase of atrial contraction, hiding the work of the conduction system, where two-thirds of its duration is the AM connection. The functions of the AM junction are multifaceted, but the main one is the regulation of the work of the chambers of the heart and the dilution of the systole of the atria and ventricles in time. The duration of the conduction of the impulse to the ventricles also varies depending on the heart rate. In this regard, an objective assessment of the actual P-0 interval during ECG analysis should be carried out taking into account the adjustment for a specific heart rate. However, in the methodology of ECG analysis until now

There is no simple and accessible method of determining the actual duration of the P-o interval, adjusted for the heart rate, which allows detecting the initial stages of the development of AM connection pathology, which are manifested in the form of relative acceleration-deceleration of AM conduction.

At the same time, early detection of manifestations of violations in the work of the AM connection allows you to take timely preventive measures to prevent the development of pathology.

There is a known method of assessing the functional state of the heart on the basis of ECG analysis (patent KO Mo 2558973, Ab1B 5/0402, publication date 08/10/2015), which consists in recording with the help of a cardiograph the ECG of the examined patient in states of rest and after physical exertion, determination with the help of hardware and software tools of the amplitude-time parameters of the corresponding cardiac cycles, including the K-B, O-T and P-O intervals, and comparison of the duration of the intervals included in the K-K interval. ECG results are used to construct cardiointervalograms (CIG), on the basis of which the number of rhythmic waves with an amplitude of 0.05 to 0.1 s and the number of cardiac cycles that make up each such rhythmic wave are determined. On the cardiointervalogram registered after physical exertion, the moment of the beginning of the first rhythmic wave with an amplitude of 0.05 to 0.1 s is determined, and based on the registration of this moment, the functional state of the atrium and ventricle is assessed. At the same time, the assessment of the functional state of the atrium is determined by the number of cardiac cycles to the first rhythmic wave in the CO-R interval, and the functional state of the ventricles is determined by the number of cardiac cycles to the first rhythmic wave in the T-0 interval. The method is used to assess the response of the cardiovascular system to physical exertion.

The method is carried out as follows.

In a patient at rest and in a sitting position, an ECG is recorded using a cardiograph in standard leads at a speed of 25 cm/min for 30-120 cardiac cycles. Second

The ECG is similarly recorded after a functional test, for example, in the form of 20 squats for 30 seconds. According to the generally accepted methodology, with the help of hardware and software, the duration of the P-O, O-T, O-R and T-O intervals is measured and the duration of each of the above intervals is calculated for both ECGs - at rest and after physical exertion, which corresponds to the time electrical systole and diastole of the atrium and ventricle and the cardiac cycle for each of the patient's conditions.

On the basis of the above calculations, construct a CGI that reflects the change in the duration of each of these ECG intervals during 30-120 cardiac cycles for states of rest and after physical exertion, determine the number of rhythmic waves with an amplitude from 0.05 to 0.1 and calculate the number of cardiac cycles , which make up each such rhythmic wave. Further, on the CGI, built according to the indications after physical exertion, the moment of the beginning of the first rhythmic wave with an amplitude of 0.05-0.1 s is determined, which in terms of duration is a wave at rest and allows us to judge the beginning of the recovery of the heart after physical exertion and the transition to state of rest The assessment of the reaction of the cardiovascular system to physical exertion is carried out using the developed normative table, in which the functional state of the atria is determined by the number of cardiac cycles to the first rhythmic wave in the O-R interval, and the assessment of the functional state of the ventricles is determined by the number of cardiac cycles to the first rhythmic wave in the T-0 interval). Thus, the method allows you to separately assess the functional state of the atria and ventricles of the patient's heart due to the separate analysis of the duration of electrical systole and diastole at rest and after physical exertion.

The disadvantages of the known method are: the complexity of implementation, associated with a large number of computational operations for assessing the functional state of the heart, which significantly increases the cost and complicates its use in practice; limited scope due to the impossibility of using it for self-monitoring by patients and medical control of the population's health during the dispensation process.

There is a known method of assessing the functional state of the heart based on ECG analysis (patent KO Mo 2180187, Ab185/02, Ab185/0402, Ab185/0452, publication date 03/10/2002), which consists in recording the patient's ECG at rest and after physical load and determining with the help of hardware and software the actual

Heart rate and amplitude-time parameters of cardiac cycles, including the actual B-H, O-T and P-O intervals. Next, an analysis of the amplitude-time indicators of cardiac cycles is performed, including in the P-O interval the area of the P5 tooth, the length of the P-O segment, and the depression of the AZT of the 5-T segment. The left ventricular dysfunction index ISI M is calculated according to the formula: m - Re -ABI.1000

R-O ches, choso. . where is the heart rate after exercise.

An increase in the CII M index is considered a negative dynamic. The basis of the method is the correlation between the occurrence of a transient increase in the P wave on the ECG at the time of the development of ischemia during exercise and a transient decrease in the contractility of the myocardium of the left ventricle - its acute ischemic dysfunction. The method is used to determine the maximum physical load for the cardiovascular system based on ECG diagnosis of ischemic dysfunction of the left ventricle.

The method allows for early diagnosis to detect precursors or the beginning of the development of left ventricular dysfunction and can be used when carrying out diagnostic stress tests to identify a risk group among patients with coronary heart disease, as well as to assess the adequacy of loads during physical training, widely used in the rehabilitation process of patients after myocardial infarction and after coronary bypass surgery. The calculation of the IOIM index can be carried out automatically by embedding the formula into the ECG processing program of the Holter monitor.

The disadvantage of the known method is the limited scope of application, due to the detection of violations of the functional state of the heart, associated only with the manifestations of ischemic dysfunction of the left ventricle.

There is a known method of assessing the functional state of the heart based on ECG analysis (patent OA Mo 54185, АЕ1В 5/0452, Аб1В 5/02, БО6М 5/00, publication date 10/25/2010), which consists in recording the patient's ECG using a cardiograph and determining with the help of hardware and software means of the actual heart rate and 10 amplitude-time parameters of cardiac cycles normalized by the heart rate, which include, among other things, the actual K-H, O-T and P-O intervals.

ECG registration is carried out in at least 20 cardiocycles in states of rest, maximum load and after the end of the patient's restitution period. Next, the average values of the actual heart rate and the mentioned parameters of the cardiac cycles registered in each of the patient's conditions are calculated, and the ratio of their average values for these conditions is determined, after which the patient's physiological condition is evaluated with a 3-point scale: low, medium and high. In the further evaluation, the ratio of the average values of the parameters calculated for the following patient states are accepted as criteria: "maximum load/state of rest" and "maximum load/after the end of the restitution period" For the ratio "maximum load/state of rest" as an indicator of a low degree of the physiological price of growth the load value is less than 0.8, and as indicators of medium and high degrees - ratios in which the value of at least one of the indicators is, respectively, in the range of 0.8-1.2 and more than 1.2. For the ratio "maximum load/after the end of the restitution period" as an indicator of a low degree of the physiological price of reducing the load, a value greater than 1.2 is accepted, and as indicators of medium and high degrees - ratios in which the value of at least one of the indicators is, respectively, in the range 0.8-1.2 and less than 0.8.

The degree of the physiological price of the load is considered low if both calculated ratios are low, and medium and high - if at least one of the ratios is medium or high, respectively. The method is used to estimate the physiological price of psycho-emotional or physical stress.

The method is carried out as follows.

Alternately, in states of rest, maximum load, and after the end of the restitution period, an ECG is taken from the patient in the first lead with the help of a cardiograph during at least 20 cardiac cycles with registration and recording in the memory of a personal computer of the actual heart rate and 10 amplitude-time parameters of cardiac cycles. Further, for the three conditions of the patient, according to the generally accepted methodology, with the help of hardware and software, average values of heart rate and amplitude-time parameters, including Ca, Ka, za,

Ta - the amplitudes of waves СО), P, 5, T, K/5 - the ratio of the amplitude of wave E to the amplitude of wave 5, OT,

ОВ5Т, РОТ, ОТ - the duration of the O wave, the OB5 complex, the P-O and O-T intervals, Tsym - the symmetry of the T wave. The specified parameters, in addition to the symmetry of the T wave, are evaluated in accordance with the standard methods adopted in electrocardiography. The symmetry of the T wave is determined in accordance with the method of ECG analysis in phase space. After that, for three different states of the patient, the ratio of the average values of the mentioned parameters, normalized to the heart rate, is calculated and his physiological state is evaluated on a 3-point scale: low, medium and high. As indicators of these conditions, the above values obtained for the ratios "maximum load/state of rest" and "maximum load/after the end of the restitution period" are accepted. Conclusion on the degree of physiological price of the load (low, medium or

Zo high) is used in sports medicine and occupational medicine to control the intensity of the load in order to optimize the training process or determine the permissible level of load in various production conditions.

The disadvantages of the known method are: insufficient clinical informativeness of the method due to the impossibility of its correlation with the causes of possible functional disorders of the cardiovascular system; the complexity of implementation associated with a large number of registered parameters in cardiac cycles and computational operations for assessing the functional state of the heart, which significantly increases the cost and complicates its use in practice; limited scope due to the impossibility of using it for self-monitoring by patients and monitoring the state of health of the population in the process of dispensation.

Thus, the known methods do not allow to fully take into account the state of intracardiac hemodynamics and diagnose the initial stages of the development of AM junction pathology.

The basis of a useful model is the task of creating a method of assessing the functional state of the heart based on ECG analysis by defining a new diagnostic criterion that allows detecting the initial signs of violations in the work of the AM connection.

The technical result of the implementation of this task consists in determining the initial signs for accurate early diagnosis of violations in the work of the AM connection and, accordingly, timely prevention of the development of the pathology of the AM connection in adults and children, which allows to significantly expand the field of application of the method, in particular in self-monitoring and medical control of adults and children.

The task is solved by the fact that in the method of assessing the functional state of the heart based on the analysis of the electrocardiogram, in which the electrocardiogram (ECG) of the examined patient is registered with the help of a cardiograph, the actual heart rate (HR) and the actual amplitude values are determined with the help of hardware and software. ace parameters of cardiac cycles, on the basis of the obtained actual K-H, O-T and P-O intervals for the actual heart rate determine the values of the appropriate O-Tc intervals and

P-Os and assess the functional state of the AM connection by deviation of the value of the actual 60 P-O interval from the value of the proper P-Os interval.

It is advisable that the value of the proper O-Ts interval be determined according to Bazett's formula:

O-Ts-KkKeUuv-V ; 0) where K is the coefficient, the value of which is 0.37 for men and children, 0.40 for women;

А-А - time parameter of the actual А-А interval, ms.

It is advisable that the value of the proper P-Os interval be determined by the formula:

RO; -032-Ts)2100 70 ; (2) where 0.3 is the physiological constant of AM conduction in the general systole of the heart.

It is also advisable that when assessing the functional state of the AM connection, the deviation of the value of the proper P-Os interval from the value of the actual interval is accepted as the norm

R-O is not more than 10 95.

The claimed method is that the ECG of the examined patient is recorded using a cardiograph and the actual heart rate is determined using hardware and software

CheS and the actual values of the amplitude-time parameters of cardiac cycles, including intervals K-H, O-T and P-O). Further, on the basis of the values of the actual intervals for the actual heart rate, with the help of hardware and software tools, the values of the appropriate intervals O-Tc and P-Os, as well as the deviation of the actual interval P-C0 from the value of the appropriate interval P-Csb, are consistently determined according to the above formulas. The deviation of the value of the proper P-Os interval from the value of the actual P-O interval by no more than 10 95 is accepted as the norm of the diagnostic criterion of the functional state of the AM connection.

The essence of the claimed method is explained by the presented figures of the drawings, where in Fig. 1 shows the ECG of the electrical systole of the heart; in Fig. 2 - a table with the results of the ECG test of the ratio of the P-O interval to the total systole of the heart; in Fig. C - a fragment of the actual ECG with normal operation of the AM connection (example 1); in Fig. 4 - the same, with a violation of AM connection - acceleration of AM conduction (example 2); in fig. 5 - the same, with a violation of AM connection - acceleration of AM conduction (example 3); in fig. 6 - the same, with a malfunction of AM

From the connection-deceleration of AM conductivity (example 4); in Fig. 7 - a table with calculated values of the proper P-O interval, corrected for heart rate.

The physiological process of the heart on the ECG is displayed in the form of an electrical systole of the heart, which occupies the segment of the ECG from the beginning of the P wave to the end of the T wave (Fig. 1). Ventricular contraction is represented on the ECG by a segment in the form of the OK5-T complex, and atrial contraction is represented by a P wave. Between the P wave and the OMK5-T complex, there is a RO segment, which reflects the pause between the contractions of the ventricles and the atria. The total duration of heart systole consists of the time of ventricular systole, atrial systole and the pause between them. If we take the duration of heart systole as 100 95, then the time of ventricular systole (OK5Z-T complex) is 70 95 of its value, and the time of atrial systole with a pause (R-C interval)) is 30 95. At the same time, the total duration of heart systole and its individual links change depending on the heart rate, and therefore an important element in the analysis of the ECG is to bring the general standard to its proper value for a specific heart rate. The appropriate time of ventricular systole (OH5-T complex) for a specific heart rate is determined by various dependencies, the most common of which is the formula

Bazette with its various modifications.

Thus, knowing the proper amount of ventricular systole time, adjusted for a specific one

CH, and its percentage ratio with the duration of heart systole, it is possible to determine the proper value of the time of the entire heart systole, and on the basis of the obtained result, calculate the value of atrial systole and pause (R-C interval) for the same heart rate.

The legality of using the percentage ratio of the time of the P-O interval to the duration of the total systole of the heart in normal and pathological conditions was verified based on the results of the analysis of a representative sample of ECGs, which includes ECGs with disorders of the AM connection in the form of acceleration-deceleration of AM conduction (Fig. 2). The mentioned percentage ratio is represented by an index in the form of the ratio Р-СО/Р-Т. The results of the test showed that with normal operation of the AM connection, the proportion of the P-O interval to the total heart systole is 30 95 and does not depend on the change in heart rate. When the conduction of the impulse to the ventricles of the heart is accelerated, the proportion of the P-0O interval to the total heart systole decreases on average to 2695, and when the conduction slows down, it increases to an average of 36 95. Thus, the P-S/P-T index has the necessary informativeness in the assessment of the functional state of the AM connection.

The deviation of the value of the proper P-0Os interval from the value of the actual P-O interval by no more than 1095 is accepted as the norm of the diagnostic criterion of the functional state of the AM connection. A deviation of more than 1095 should be considered as a relative acceleration-deceleration of AM conduction. The selection of a relatively shortened P-O interval is associated with the presence of a risk of rhythm disturbance in tachycardia, since, if in the group of people with an absolutely shortened P-O interval, the risk of rhythm disturbance in tachycardia occurs in 78.9 95 cases, then in the group with with a relatively shortened P-O interval, it occurs almost in half - up to 41.5 95. Another form of pathology of the AM connection manifests itself in the form of a slowing of the impulse conduction to the ventricles of the heart, and on the ECG it is registered with a lengthening of the P-O interval.

The use of the method is explained on the examples of determining the functional state of the heart.

Example 1 (Fig. 3)

The examined patient is a woman. At rest, the heart rate on the ECG is 85 beats per minute. According to the results of deciphering the cardiological indicators on the ECG, their duration was: interval K-B8-702 ms, interval P-O-149 ms, and interval O-T-342 mo.

Calculation of the appropriate value of the О-Тс interval is carried out according to Bazett's formula (1) for

K-0.40 and K-K-0.702 p. According to the results of the calculation, the value of the O-Ts interval was 0.334 s. Based on the value of the proper O-Ts interval using formula (2), we calculate the proper p-Os interval. Its value was 143 ms and is within the standard with the actual P-o interval, as the deviation between their values is 4.195. Thus, the patient has no signs of disturbances in the functional state of the AM connection.

Example 2 (Fig. 4)

The examined patient is a man. At rest, the heart rate of 73 reductions per minute was registered on the ECG. According to the results of deciphering the cardiological parameters on the ECG, their duration was: interval K-B-818 ms, interval P-O-122 ms (norm - 120-200 ms), interval O-T1-350 mo.

According to the results of the calculation, the proper interval O-Ts was 334 ms, the proper interval P-

Os-144 ms. The ratio between the values of the actual and the proper P-O interval was 16 95 in the downward direction, which indicates a violation of the operation of the AM connection - acceleration of conduction

From the impulse to the ventricles with the presence of a pronounced risk of rhythm disturbance in tachycardia

Example C (Fig. 5)

The examined patient is a woman. At rest, the heart rate of 77 contractions per minute was recorded on the ECG. According to the results of decoding on the ECG of the cardiological indicators, their duration was: interval K-B-782 ms, interval P-O-124 ms (norm - 120-200 ms), interval O-1-340

Mo.

According to the calculation results, the proper O-Ts interval was 354 ms, the proper P-

About 152 ms. The ratio between the values of the actual and proper P-O interval was 18.5 95 downwards, which indicates a violation of the AM connection - acceleration of the conduction of the impulse into the ventricles with the presence of a pronounced risk of rhythm disturbances in tachycardia.

Example 4 (Fig. 6)

The examined patient is a woman. At rest, the heart rate of 76 contractions per minute was registered on the ECG. According to the results of decoding on the ECG of the cardiological parameters, their duration was: interval K-B-790 ms, interval P-O-200 ms (norm - 120-200 ms), interval O-T-380

Mo.

According to the results of the calculation, the proper interval O-Ts was 355 ms, the proper interval P-

About 152 ms. The ratio between the values of the actual and proper P-O interval was 31.5595 in the increasing direction, which indicates a violation of the work of the AM connection - a slowing down of the conduction of the pulse along the AM connection, on the border of the AM blockade.

The calculation of the values of the appropriate C-Ts interval and the appropriate P-Os interval can be performed automatically using a computer program when processing the relevant ECG data on a personal computer. Operational determination of the appropriate P-O interval depending on heart rate can be performed according to the table (Fig. 7). Estimated values of the proper P-Os interval can be used when performing self-monitoring and medical monitoring.

The claimed method makes it possible to determine with sufficient clinical informativeness the functional state of the AM junction, including within the general norm of the P-O interval, which is from 120 to 200 ms, and to timely detect the initial stages of the development of the pathology of the AM junction, which appear in the form of relative acceleration-deceleration of AM conductivity. because the ease of implementation of the specified method allows to recommend it for use in cardiology, pediatrics, functional diagnostics, sports medicine and during medical control for early diagnosis and prevention of the development of AM junction pathology in adults and children of all age groups.

Claims (1)

USEFUL MODEL FORMULA 1. The method of assessing the functional state of the heart based on the analysis of the electrocardiogram, in which the electrocardiogram (ECG) of the examined patient is registered with the help of a cardiograph, the actual heart rate (HR) and the actual values of the amplitude-time parameters of the cardiac cycles are determined with the help of hardware and software tools, on on the basis of the obtained actual intervals К-В, ОО-Т and Р-О for the actual heart rate, determine the values of the proper intervals С-Тс and Р-Ос, evaluate the functional state of the AM connection by the deviation of the value of the actual Р-О interval from the value of the proper interval Р -Os. 2. The method according to point 1, which differs in that the value of the proper O-Ts interval is determined by the Bazette formula: O-Ts-KeUup-B where K is a coefficient whose value is 0.37 for men and children, 0.40 for women; В-В - time parameter of the actual К-К interval, me. C. The method according to point 1, which differs in that the value of the appropriate P-Os interval is calculated according to the formula: - Ts)e100 RO; -035-T0)e100 70 , where 0.3 is the physiological constant of AM conductivity in the general systole of the heart. 4. The method according to point 1, which differs in that when assessing the functional state of the AM connection, the deviation of the value of the proper P-Os interval from the value of the actual P-O interval is taken as a norm by no more than 10 95. and Yanlanyasya Y v-ad at BO Bestennnyi SHIN SHI Yanuteunii | Жеерек | E What what. SHO in-ti currents and about the thorns of Zbec | ! Dental EK Jannleje Fig. 1 / indee МАМ Average value of HRS HRS HR and Normal ZB zbe iv,-yao ZOyu Zo ZI. ОУкороченный бе 0 ея, от О ЗБ Ой |В Повеженый РО 3а9а434,2-37,85) шиши - horn. CHOS - 85 breaths; V-Y - 702 me, RO) - 149 me, O-T- 343 mo, gender - female mon ZHOV o v. sHE in pos. p p o p shin shin her p ne o V NN ok NI VE m o a y Fi. WITH YOU NDEXROK-iyaM What o ne o shen sh-e la ne i v ya sha o ek mon Fig. 4. VAK LIS RA NU ve NK NN OK BV m SHYN she p ty EK PE «A i ny sa Ves va Yang. 5 Vk i ev v ny m MNN NN NN Ya schi el o pav ho 0 SHY 5 On 0 NN v V nyu PV ov ono V i Yan nn i v a NN DEPO DK KAM dn UK KYT TYZH KYY Mk Х TITITNO fig. 6 Itnzervazh iy. Me! HRS Tyutraeooi, me| Interval of ohms and km skh NI NN S NN shi zh sh kh hu zh lish 006 ShK Va | 002105 yati shi shi mo Tu sun b nn and 05 od V, ! vvo 23-06 152 WHAT ARE YOU and what are we KON kN! 0 SHO bla KD St nim NN VSU ZH KEN NOKNONE K VN iia 655 09 1 obodi 1 sha NO A VS U ZY NN TNK IN MY EN INA tk: VI PON E Z va 155 yav 109 Shchi Fig. 7