ДИФФЕРЕНЦИАЛЬНАЯ ДИАГНОСТИКА ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ И ХРОНИЧЕСКОЙ ДЫХАТЕЛЬНОЙ НЕДОСТАТОЧНОСТИ У ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНЬЮ ЛЕГКИХ

Abstract

Chronic respiratory failure (CRF) has traditionally been considered to be the main cause of death in patients with chronic obstructive pulmonary disease (COPD). However, modern epidemiological studies have shown that the leading causes of death in patients with COPD are CHD and CHF. Aim: to study the prevalence of CRF and CHF in patients with COPD, to determine the informative value of clinical symptoms in their diagnosis, to work out an algorithm of differential diagnosis of CRF and chronic heart failure (CHF). Methods: subjects – 100 men with COPD. The median age was 67 years. We performed clinical and laboratory examinations. COPD syndrome was diagnosed upon EchoCG and NT-proBNP results. CRF syndrome was diagnosed by the results of exercise testing with simultaneous measurement of arterial blood hemoglobin oxygen saturation. Results: CHF was established in 45.0% of patients, and right ventricular failure was diagnosed in 42.0% of cases. Patients with CHF and decreased left ventricular EF, whose prognosis could be improved by evidence-based treatment developed at the present stage, comprised only 12.0%. We revealed the correlation of CHF syndrome with CRF and with disorders of arterial blood hemoglobin oxygen saturation: CHF NYHA III is associated with CRF IIIB and any disorders of arterial blood hemoglobin oxygen saturation, while CHF NYHA II and NYHA I are respectively associated with CRF IIIA and CRF IIB as well as with a decrease in arterial blood hemoglobin oxygen saturation both on exertion and at rest. The informative value of clinical symptomatology was assessed in COPD patients for the diagnosis of CHF and CRF syndromes: the probability of CHF diagnosis based on clinical symptoms is 79.0% and for CRF – 88.0%. A symptom score scale and an algorithm for the diagnosis of CHF and CRF were developed.