RU-2861543-C1 - METHOD FOR ULTRASOUND DIAGNOSTICS OF HAEMODYNAMICALLY SIGNIFICANT CORONARY ARTERY STENOSIS IN VARIANT FORMS OF HYPERTROPHIC CARDIOMYOPATHY

Abstract

FIELD: medicine; cardiology. SUBSTANCE: invention can be used for ultrasound diagnostics of haemodynamically significant coronary artery stenosis in variant forms of hypertrophic cardiomyopathy. Two-dimensional echocardiography is performed to determine the type of hypertrophic cardiomyopathy: septal, diffuse, or apical. Sequential archiving of video images of the left ventricle of the heart in B-mode in the apical five-chamber, apical four-chamber, and apical two-chamber positions is performed with simultaneous recording of an electrocardiogram. A speckle tracking programme is activated, the examination zones are adjusted, dividing the left ventricle into 17 segments, in which the regional systolic longitudinal strain is determined. Finally, the global longitudinal strain of the left ventricle is calculated, averaged from the 17 segments. Complication by haemodynamically significant coronary artery stenosis in hypertrophic cardiomyopathy is indicated by the values of global longitudinal strain of the left ventricle according to speckle tracking echocardiography: ≥-12.9% for the septal variant, ≥-11.1% for the diffuse variant, and ≥-10.2% for the apical variant. EFFECT: possibility of increasing the accuracy and objectivity of non-invasive detection of haemodynamically significant coronary artery stenosis in patients with various forms of hypertrophic cardiomyopathy (HCM), which will minimise the number of unjustified invasive interventions by taking into account the variability of myocardial strain characteristics in different forms of HCM. 1 cl, 6 dwg, 6 ex

Inventors

• Akramova Endzhe Gamirovna
• Akramova Zilia Nailevna

Dates

Publication Date

20260505

Application Date

20251009

Claims (5)

1. A method for ultrasound diagnostics of hemodynamically significant stenosis of the coronary arteries in variable forms of hypertrophic cardiomyopathy, characterized by the fact that two-dimensional echocardiography is performed, the type of hypertrophic cardiomyopathy is determined: septal, diffuse or apical, while sequentially archiving a video image of the left ventricle of the heart in B-mode in the apical five-chamber, apical four-chamber and apical two-chamber positions with parallel registration of the electrocardiogram, then turning on the speckle tracking program, adjusting the study zones, dividing the left ventricle into 17 segments, in which the regional systolic longitudinal deformation is determined, and finally the global - averaged from 17 segments, longitudinal deformation of the left ventricle is calculated;
2. Moreover, the complication of hemodynamically significant stenosis of the coronary arteries in hypertrophic cardiomyopathy is indicated by the values of global longitudinal deformation of the left ventricle according to speckle-tracking echocardiography:
3. ≥-12.9% in septal hypertrophic cardiomyopathy;
4. ≥-11.1% in the diffuse variant of hypertrophic cardiomyopathy;
5. ≥-10.2% in apical hypertrophic cardiomyopathy.

Description

The invention relates to medicine and can be used for ultrasound diagnostics of hemodynamically significant stenosis of the coronary arteries in patients with hypertrophic cardiomyopathy. Further in the text, the applicant provides terms and abbreviations used in this description. BP – arterial pressure. HCM – hypertrophic cardiomyopathy. IHD – ischemic heart disease. HR – heart rate. ECG – electrocardiography. Speckle-tracking echocardiography (speckle-tracking) is an ultrasound diagnostic method that allows for the precise assessment of myocardial strain at various phases of the cardiac cycle. Unlike standard echocardiography, which measures only global contractility, speckle-tracking reveals early disturbances in local contractility, even when the ejection fraction remains normal [https://donzdrav.com/uslugi/funktsionalnaya-diagnostika/uzi/uz-diagnostika/uzi-strejn-ekhokardiografiya-spekl-treking-otsenka-funktsii-miokarda]. A source was identified from the studied level of technology [Gabrusenko S.A., Gudkova A.Ya., Koziolova N.A., Alexandrova S.A., Berseneva M.I., Gordeev M.L., Dzemeshkevich S.L., Zaklyazminskaya E.V., Irtyuga O.B., Kaplunova V.Yu., Kostareva A.A., Krutikov A.N., Malenkov D.A., Novikova T.N., Saidova M.A., Sanakoev M.K., Stukalova O.V. Hypertrophic cardiomyopathy. Clinical guidelines 2020. Russian Journal of Cardiology. 2021;26(5):454], the essence is the description of HCM - a genetically determined myocardial disease characterized by left ventricular myocardial hypertrophy (more than 1.5 cm), which cannot be explained solely by an increase in pressure load. The disadvantage of the known source compared to the declared technical solution is the verification of only pronounced hypertrophy by echocardiography, but not its combination with coronary atherosclerosis. It is known that the incidence rate of HCM among those seeking medical care is 1:300 [Komissarova S.M., Rineyskaya N.M. Updated clinical guidelines esc-2023 for the diagnosis and treatment of hypertrophic cardiomyopathy. Medical news. 2023;350(11):56-62]. Coronary artery disease (CAD) in HCM significantly worsens the prognosis and changes treatment strategies. Coronary angiography (the "gold standard" for diagnosing coronary artery disease) is an unsafe and expensive procedure. The clinical and electrocardiographic (ECG) manifestations of these two conditions overlap, complicating their differential diagnosis. Echocardiography is widely recognized as the leading noninvasive imaging diagnostic method for examining cardiac patients [Alekhine, M.N. Clinical Use of Left Ventricular Longitudinal Systolic Strain Indicators. Kremlin Medicine. Clinical Bulletin. 2017; 4:101-111]. A well-known source describes the use of an ultrasound scanner equipped with speckle-tracking technology, which allows for the determination of global left ventricular longitudinal strain, a reduction of which suggests the presence of coronary atherosclerosis in a patient. From the studied level of technology, a patent for invention RU 2613085 "Method for early diagnosis of myocardial dysfunction in idiopathic hypertrophic cardiomyopathy in children" was identified, the essence of which is a method for early diagnosis of myocardial dysfunction in idiopathic hypertrophic cardiomyopathy in children, characterized in that a two-dimensional echocardiographic study of the myocardium is performed with speckle motion analysis and parallel recording of an electrocardiogram, study zones are allocated on the images of the left ventricle at the level of its base and middle third along the short axis of the heart, obtained from the parasternal position, each study zone is divided into lower, posterior, lateral, anterior, anterior septal and septal segments, in which the average indicators of regional radial deformation at the time of systole are determined, the average indicators of regional radial deformation are calculated separately for the studied segments of the base and middle third of the left ventricle and if the value of at least one of them is less than 20%, a diagnosis is made myocardial dysfunction. The disadvantage of the known technical solution compared to the declared one is that in HCM in adults, pronounced hypertrophy of the left ventricular myocardium causes a decrease in regional deformation of less than 20% and in the absence of coronary atherosclerosis, which does not allow the use of this quantitative criterion for verifying the combination of HCM and coronary heart disease in adults. The technical problem solved by the claimed invention and its technical result are the objective selection of patients for coronary angiography based on the results of ultrasound diagnostics of hemodynamically significant coronary artery stenosis in patients with hypertrophic cardiomyopathy (HCM) by substantiating the threshold value of global longitudinal strain using speckle-tracking echocardiography. Unlike the invention according to patent RU 2613085, global longit