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.
Highlights
28 patients with chronic heart failure (CHF) of ischemic genesis who were on treatment at the State Regional Clinical Hospital
their relatives were interviewed for their adverse outcomes
CHF is accompanied by an increase in the likelihood
Summary
Сердечно-сосудистые заболевания являются основной пол, возраст старше 40 и менее 80 лет; наличие диагностипричиной смертности во всем мире, составляя 17,3 млн. рованной ХОБЛ согласно рекомендациям GOLD (2013 г.). По сравнению с пациентами с изолированной ХСН у лиц с сочетанной патологией в течение года наблюдения в 2,98 раза реже отмечались сердечно-сосудистые осложнения, в то же время общая смертность была в 3,28 раза выше. Декомпенсация ХСН в 3,6 раза чаще развивалась у пациентов с ХОБЛ и ХСН ишемического генеза, чем у больных без перенесенного ИМ. Целью анализа стало определение взаимосвязи вероятности декомпенсации ХСН, развития сердечно-сосудистых катастроф и летального исхода в зависимости от исходной величины изучаемых клинико-инструментальных параметров у больных ХОБЛ и ХСН. При проведении корреляционного анализа установлены взаимосвязи между увеличением общей смертности ассоциировано с наличием СД, высоким ФК стенокардии, выраженностью СН (стадия, ФК по ШОКС), тяжестью ХОБЛ (частота обострений за прошедший год, объема форсированного выдоха за 1 сек (ОФВ1), количеством баллов по САТ, значением индекса BODE), интенсивностью курения, с развитием гипертрофии ПЖ (толщина правой стенки) и повышенной артериальной ригидностью (СРПВ за сутки). Клиническая характеристика больных ХОБЛ и ХСН в зависимости от наличия декомпенсации СН в течение года
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