Clinical and functional cardiovascular disorders in patients with chronic obstructive pulmonary disease and chronic heart failure
https://doi.org/10.18093/0869-0189-2008-0-2-62-67
Abstract
The study was aimed to investigate clinical and functional particularities of cardiovascular system in patients with COPD and chronic heart failure (CHF). We examined 1737 patients, of them, 498 with COPD (the 1st group), 721 with COPD and concomitant class I to III stable angina (the 2nd group), and 519 with class I to III stable angina (the 3rd group). All the patients also had CHF. The study included clinical assessment using modified R. Cody's scale, ECG, Holter monitoring, lung function testing, Doppler echocardiography, 6-minute walk test (6MWT). Obstructive disorders were found in 424 of the 2nd group patients (58.8 %) and 268 of the 3rd group patients (51.7 %). Number of patients with class II to IV chronic cor pulmonale was similar in all groups. The class III was determined more often in the 2nd group (36.5 %; р < 0.05), the class I prevailed in the 1st group (17.8 %; р < 0.05). The stage I CHF predominated in the 1st group (31.9 %; р < 0.05), the stages IIА and IIБ were seen mainly in the 2nd group (51.6 % and 26.4 % respectively; р < 0.05). The majority of the 3rd group patients (57.3 %) had the stage IIA CHF. According to most clinical signs, CHF was more severe in the 2nd group. 6MWT was 308.08 ± 6.03 m in the 1st group, 156.4 ± 4.38 m in the 2nd group, and 212.8 ± 5.65 m in the 3rd group (р < 0.05). Low left ventricular (LV) ejection fraction was seen significantly more often in COPD patients with concomitant angina. This group as well as COPD patients had significantly higher mean pulmonary artery pressure (mPAP) (24.7 ± 0.41 mm Hg and 29.9 ± 0.27 mm Hg respectively) compared to 21.7 ± 0.07 mm Hg in the 3rd group patients. Right ventricular (RV) diastolic dysfunction was revealed in 154 patients of the 1st group (83.7 %), 194 patients of the 2nd group (91.9 %) and 72 patients of the 3rd group (43.1 %). In conclusion, all the patients had RV and LV remodeling signs. COPD patients had more prominent RV hypertrophy and dilation, angina patients had enlargement of left heart and moderate decrease in LV contractility. The patients with COPD and angina had the greatest increase in size and wall thickness of both LV and RV and low pump function of LV.
About the Authors
Ya. N. Shoikhet
НИИ пульмонологии при Центральной научно'исследовательской лаборатории Алтайского государственного медицинского университета
Russian Federation
Russian Federation
E. B. Klester
НИИ пульмонологии при Центральной научно'исследовательской лаборатории Алтайского государственного медицинского университета
Russian Federation
Russian Federation
References
1. Chen J.C., Mannino M.D. Wordlwide epidemiology of chronic obstructive pulmonary disease. Curr. Op. Pulm. Med. 1999: 5: 93–99.
2. Айсанов З.Р., Калманова Е.Н., Чучалин А.Г. Хроническая обструктивная болезнь легких в сочетании с сердечнососудистыми заболеваниями: лечение ингаляционными холинолитическими препаратами. Тер. арх. 2004; 12: 81–82.
3. Глобальная стратегия диагностики, лечения и профилактики хронической обструктивной болезни легких. Пересмотр 2003 г.: Пер. с англ. под ред. А.Г.Чучалин. М.: Атмосфера; 2003.
4. Батыралиев Т.А., Махмутходжаев С.А., Першуков И.В. и др. Легочная гипертензия и правожелудочковая недостаточность. Часть I. Кардиология 2006; 2: 74–82.
5. Karatasakis G.T., Karagounis L.A., Kalyvas P.A. et al. Prognostic significance of echocardiographically estimated right ventricular shortening in advanced heart failure. Am. J. Cardiol. 1998; 82 (3): 329–334.
6. Kohama A., Tanouchi J., Masatsugu H. et al. Pathologic involvement of the left ventricle in chronic cor pulmonale. Chest 1990; 98: 794–800.
7. Национальные рекомендации ВНОК и ОССН по диагностике и лечению ХСН (второй пересмотр). Сердеч. недостат. 2006; 7 (2): 52–80.
8. Reybrouck T. Clinical usefulness and limitations of the 6-minute walk test in patients with cardiovascuiar or pulmonary disease. Chest 2003; 123 (2): 325–327.
9. Kitabatake A., Inoue M., Asao M. et al. Noninvasive evaluation of pulmonary hypertension by a pulsed doppler technique. Circulation 1983; 68: 302–309.
10. Ishikura F., Redfield M.M. Doppler echocardiography assessment of diastolic function in congestive heart failure: emphasis on clinical utility. Heart Fail. 1998; 14: 78–96.
11. Дембо А.Г. Недостаточность функции внешнего дыхания. Л: Медицина; 1957.
12. Канаев Н.Н. О формах и степенях недостаточности внешнего дыхания. В кн.: Руководство по клинической физиологии дыхания. М: Медицина; 1980: 346–358.
13. Диагностика и коррекция нарушений липидного обмена с целью профилактики и лечения атеросклероза. Российские рекомендации. Разработаны Комитетом экспертов ВНОК. Кардиоваск. тер. и профилакт. 2004; прил.: 1–36.
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For citations:
Shoikhet Ya.N., Klester E.B. Clinical and functional cardiovascular disorders in patients with chronic obstructive pulmonary disease and chronic heart failure. PULMONOLOGIYA. 2008;(2):62-67. (In Russ.) https://doi.org/10.18093/0869-0189-2008-0-2-62-67
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