Факторы риска развития неблагоприятных исходов у пациентов с хронической обструктивной болезнью легких и хронической сердечной недостаточностью

Abstract

To identify markers of adverse outcomes in patients with a combination of chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). 35 patients with COPD (without an anamnesis of coronary heart disease), 68 patients with COPD and CHF, 28 patients with CHF of ischemic genesis who were on treatment at the State Regional Clinical Hospital of Saratov were examined. The levels of the N-terminal fragment of the natriuretic peptide, galectin-3, the highly sensitive C-reactive protein, the proteins that bind fatty acids, the stiffness parameters of the arterial wall were determined; echocardiography was performed, calculated the index of comorbidity of Charlson. A year after entering the study, patients or their relatives were interviewed for their adverse outcomes. The combination of COPD and CHF is accompanied by an increase in the likelihood of the development of heart failure decompensation compared with the isolated course of COPD. The main causes of death of patients with combined pathology were respiratory failure and cardiovascular complications. Decompensation of CHF was 3,6 times more likely in patients with COPD and CHF of ischemic origin than in patients without previous myocardial infarction. The risk group the development of acute decompensation of heart failure within the next year is composed of patients with COPD and CHF having 3-4 functional classes of CHF, signs of decompensation in the small circulation, angina pectoris, past myocardial infarction. The most significant prognostic echocardiographic parameters were marked dilatation of the left auricles, reduction of the left ventricular ejection fraction less than 45%. The development of cardiovascular complications in patients with COPD and CHF is interrelated with an increase in arterial rigidity. The increase in total mortality is associated with the severity of heart failure and increased 24-hour arterial rigidity. The obtained results will allow to form high-risk groups and optimize the treatment-diagnostic process.