Русский
Features of the early detection of heart failure in chronic obstructive pulmonary disease
DOI: https://dx.doi.org/10.18565/therapy.2020.5.78-84
Koliev V.I., Sarapulova I.Y., Kravchenko V.N., Shaposhnik I.I., Ryabova L.V.
1) South Ural State medical University of the Ministry of Healthcare of Russia, Chelyabinsk; 2) Chelyabinsk City hospital No. 1
Purpose: to identify the features of the detection of chronic heart failure (CHF) in chronic obstructive pulmonary disease (COPD).
Material and methods. 100 patients (men) were examined with a diagnosis of COPD II–IV degree, without exacerbation. Patients were divided into 2 groups: 1 - patients with COPD in combination with heart failure (n=40); 2 - patients with COPD without heart failure (n=60). The average age of patients is 64,4±0,74 years. Research methods: medical history, clinical examination, dyspnea scale mMRS and CAT, echocardiography, spirometry, chest X-ray, pulse oximetry, C-reactive protein, acid-base blood composition, cerebral natriuretic peptide (NT-proBNP).
Results. Among 100 examined patients with COPD, 40% (n=40) revealed CHF. The presence of heart failure, in addition to physical examination, was also determined by the level of NT-proBNP and echocardiography. Among group 1 patients, a preserved left ventricular (LV) ejection fraction of more than 50% was observed in 24 patients. At the same time, coronary heart disease served as the main cause of LV systolic dysfunction (n=16), while arterial hypertension was the cause of LV diastolic dysfunction. In all examined patients, spirography confirmed COPD (Gensler index <70%). In patients with combined pathology, a decrease in exercise tolerance was noted (the sum of SHOC scores in group 1 was 5,44±0,46, in group 2 – 2,14±0,19; p <0,05), and higher mean pressure values in pulmonary artery (30,2±1,22 mm Hg.Art. vs. 22,4±0,71 mm hg. art. in the group without heart failure; p <0,01), a higher severity score of dyspnea mMRC (degree in the group with combined pathology – 2,46 ±0,15, in the group without heart failure – 1,88±0,13; p <0,05) and the COPD COP test (in the 1 group – 18,1±1,13, in 2 group – 14,9±0,82; p=0,028).
Conclusion. Thus, in order to detect CHF in patients with COPD, taking into account the commonality of symptoms, the following were used: screening of the level of natriuretic peptides and echocardiography. The method of tissue Doppler study allowed to evaluate the LV diastolic function.
Material and methods. 100 patients (men) were examined with a diagnosis of COPD II–IV degree, without exacerbation. Patients were divided into 2 groups: 1 - patients with COPD in combination with heart failure (n=40); 2 - patients with COPD without heart failure (n=60). The average age of patients is 64,4±0,74 years. Research methods: medical history, clinical examination, dyspnea scale mMRS and CAT, echocardiography, spirometry, chest X-ray, pulse oximetry, C-reactive protein, acid-base blood composition, cerebral natriuretic peptide (NT-proBNP).
Results. Among 100 examined patients with COPD, 40% (n=40) revealed CHF. The presence of heart failure, in addition to physical examination, was also determined by the level of NT-proBNP and echocardiography. Among group 1 patients, a preserved left ventricular (LV) ejection fraction of more than 50% was observed in 24 patients. At the same time, coronary heart disease served as the main cause of LV systolic dysfunction (n=16), while arterial hypertension was the cause of LV diastolic dysfunction. In all examined patients, spirography confirmed COPD (Gensler index <70%). In patients with combined pathology, a decrease in exercise tolerance was noted (the sum of SHOC scores in group 1 was 5,44±0,46, in group 2 – 2,14±0,19; p <0,05), and higher mean pressure values in pulmonary artery (30,2±1,22 mm Hg.Art. vs. 22,4±0,71 mm hg. art. in the group without heart failure; p <0,01), a higher severity score of dyspnea mMRC (degree in the group with combined pathology – 2,46 ±0,15, in the group without heart failure – 1,88±0,13; p <0,05) and the COPD COP test (in the 1 group – 18,1±1,13, in 2 group – 14,9±0,82; p=0,028).
Conclusion. Thus, in order to detect CHF in patients with COPD, taking into account the commonality of symptoms, the following were used: screening of the level of natriuretic peptides and echocardiography. The method of tissue Doppler study allowed to evaluate the LV diastolic function.
Keywords: chronic obstructive pulmonary disease, chronic heart failure, diastolic form of heart failure
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About the Autors
Vyacheslav I. Koliev, Senior laboratory assistant of the Department of propaedeutics of internal diseases of South Ural State medical University of the Ministry of Healthcare of Russia, cardiologist of Chelyabinsk City hospital No. 1. Address: 454048, Chelyabinsk, 16 Vorovskogo Str. Tel.: +7 (919) 111-10-22. E-mail: s.koliev8@gmail.com
Iraida Y. Sarapulova, functional diagnostician of Chelyabinsk City hospital No. 1. Address: 454048, Chelyabinsk, 16 Vorovskogo Str. Tel.: +7 (902) 612-59-07
Victoria N. Kravchenko, functional diagnostician of Chelyabinsk City hospital No. 1. Address: 454048, Chelyabinsk, 16 Vorovskogo Str. Tel.: +7 (905) 835-02-86
Igor I. Shaposhnik, MD, professor, head of the Department of propaedeutics of internal diseases of South Ural State medical University of the Ministry of Healthcare of Russia, cardiologist of Chelyabinsk City hospital No. 1.
Address: 454092, Chelyabinsk, 64 Vorovskogo Str. Tel.: +7 (908) 823-51-20
Liana V. Ryabova, MD, associate professor of the Department of propaedeutics of internal diseases of South Ural State medical University of the Ministry of Healthcare of Russia, pulmonologist of Chelyabinsk City hospital No. 1.
Address: 454092, Chelyabinsk, 64 Vorovskogo Str. Tel.: +7 (951) 260-56-35
