Mathematical analysis of daily ECG in assessing the effectiveness of obesity treatment in young patients

Abstract

Mathematical analysis of the ECG in medicine has been used for a long time, since in 1932 Fleisch and Beckmann first applied the mathematical assessment of the heart rate using the standard deviation of the R-R intervals to assess fluctuations. Mathematical analysis technologies are constantly developing and improving and are the method of choice in the analysis of heart rate variability (HRV). HRV analysis is based on the measurement of time intervals between adjacent ECG R-waves with the construction of a dynamic series - a cardiorhythmogram (CRG). Evaluation of HRV allows to obtain data not only on the functioning of the patient's cardiovascular system, but also on the tension (or exhaustion) of regulatory mechanisms (the state of autonomic regulation), and hence on the preservation of adaptation reserves and rehabilitation capabilities of the body. And this opens opportunities for predicting and monitoring the effectiveness of therapy. At present, the leading direction of research is the development of practical aspects of applying the results of daily HRV analysis.Purpose. To evaluate the possibilities of HRV analysis in monitoring the effectiveness of treatment in young patients with obesity.Materials and methods. Patients with exogenous constitutional obesity underwent 24-hour monitoring of heart rate (Holter monitoring - HM) with software computer analysis of the wave spectrum of the obtained data and selection of frequencies - 0.004–0.08 Hz (very low frequencies - VLF); 0.09-0.16 Hz (low frequencies - LF); 0.17-0.5 Hz (high frequencies - HF); more than 0.5 Hz (Ultra Low Frequency Waves - ULF). Two coefficients were calculated - LF/HF (coefficient of vagosympathetic balance) - the ratio of the power of low frequency waves (LF) to the power of high frequency waves (HF) and the index of centralization (CI) - the ratio of the activity of the central circuit of regulation to the autonomous one (LF+VLF/HF).Results. In total, 14 young patients (from 17 to 26 years old) who were admitted to the medical center with a diagnosis of exogenous constitutional obesity were examined. The survey complex included an analysis of HRV. The initial indicator of autonomic balance was determined by the coefficient LF/HF and the degree of tension of regulatory systems by the index of centralization (CI). In young people, parasympathetic activity prevailed in the wave spectrum - % of high frequency waves (HF) characterizing parasympathetic activity exceeded % of low frequency waves (LF) characterizing sympathetic activity. The follow-up period ranged from 8 months to 1.5 years.In the examined patients, at the beginning of the observation, the predominance of parasympathetics was noted in all, and the value of the coefficient below 0.7 was found in 14 people. (85.7%), which confirmed the predominance of parasympathetics with a significant violation of the autonomic balance (in healthy individuals, the ratio of sympathetic/parasympathetic in terms of LF/HF is from 0.7 to 1.5.). Since the treatment of obesity is a long process, to assess the adequacy of the therapy, after 1 month all patients underwent a second HRV study and the correlation with the effectiveness of the therapy was evaluated. Treatment of obesity was effective in those patients who had their LF/HF increased to a level above 0.7, and the index of centralization increased by more than 50% of the initial level after 1 month. For these patients (11 people - 78.6%), the appropriate treatment tactics were chosen, and the treatment should be continued without additional correction. In patients who did not reach the level of eutonia, the effect of therapy on weight loss was unsatisfactory and relapse of the disease was noted in all cases.Conclusion. Mathematical analysis of HRV in young patients with exogenous constitutional obesity makes it possible to control the state of vegetative balance and, on this basis, to predict the effectiveness of the complex of therapy in a particular patient. If after a month we observe that the predominance of parasympathetics persists (especially during daytime), as well as the high tension of regulatory systems, the complex of therapeutic measures requires immediate correction