Вероятность желудочковой экстрасистолии высоких градаций у пациентов с хронической сердечной недостаточностью в коморбидности с хронической обструктивной болезнью легких

Abstract

Ventricular arrhythmias, including extrasystoles, are among the leading causes of sudden cardiac death, including in patients with chronic heart failure, therefore, the identification of ventricular extrasystoles (VE) of high gradations, as well as the prediction of adverse cardiovascular events (ACE) in this group of patients remain the priority tasks of cardiology. The purpose — to develop an integrative model of the probability of high-grade ventricular extrasystoles in patients with chronic heart failure (CHF) in association with chronic obstructive pulmonary disease (COPD). Material and methods. 134 patients with CHF and ischemic heart disease were included, 67 of them also suffering from COPD (groups 1 and 2). All patients underwent the following examinations: 6-minute walking test, assessment of clinical status, assessment of life quality by Minnesota scale, examination of respiratory function, echocardiography, and daily electrocardiogram monitoring. The classification of ventricular extrasystoles by Ryan M. (1975) in McKenna W. modification was used. Ventricular extrasystoles grade IIIА and higher were classified as high grade extrasystoles. To develop a model for predicting high-grade ventricular extrasystoles, the method of binary logistic regression was used. Results. No significant differences were found for functional class (FC) of CHF, walking test results, and gender. The average number of VE in the CHF group was 7 [0; 232.0] per day, while with CHF in combination with COPD — 27 [2.0; 292.0], (p = 0.142). The structure in the patients with CHF differed from those with CHF combined with COPD. So, in the CHF group, there was no VE in 30 people (44.8%), grade 1–2 was observed in 17 people (25.4%), grade 3А and higher — in 20 people (29.8%). In patients with CHF in combination with COPD, VE was absent in 17 people (25.4%), grade 1–2 was observed in 22 people (32.8%), 3А and above — in 28 people (41.8%). In patients with CHF in combination with COPD, VE was less often absent (chi-square = 5.54, p = 0.018). In the CHF group, correlations were found between the number of VE and the male gender (r = -0.31, p <0.05), age (r = 0.30, p <0.05), end diastolic volume (r = 0.51, p <0.05), end systolic volume (r = 0.54, p <0.05), end diastolic size (r = 0.36, p <0.05), end systolic size (r = 0, 51, p <0.05), left ventricular ejection fraction (r = -0.52, p <0.05), and left ventricle myocardium mass (r = 0.52, p <0.05). In the CHF group in combination with COPD, correlations were different. We found correlations between the number of premature ventricular contractions and male gender (r = -0.34, p <0.05), forced expiratory volume in the first second (r = -0.34, p <0.05), forced vital capacity of the lungs (r = -0.27, p <0.05), minute volumetric velocities during exhalation of 25% (r = -0.25, p <0.05) and 50% (r = -0.31 , p <0.05), end diastolic size (r = 0.43, p <0.05), end systolic size (r = 0.50, p <0.05), and left atrial size (r = 0, 29, p <0.05). According to the obtained data, in the CHF with COPD group, the predictors of high grade VE are of forced expiratory volume in the first second (р = 0,004, Wald = 8,22) and the end diastolic size of the left ventricle (р=0,027, Wald=4,90). Conclusion. The results of the study demonstrated that in CHF and CHF in combination with COPD, the predictors of high grade ventricular extrasystoles are different. Thus, in CHF, the parameters of echocardioscopy are interrelated to a greater extent with ventricular extrasystoles, and in the combination of CHF and COPD, spirometry parameters, which probably leads to unfavorable outcomes and requires an integral approach to patient management tactics and stratification of the risk of adverse events.