Abstract
Objective: to identify the features of structural and functional remodeling of the right heart in patients with chronic heart failure (CHF) against the background of a combination of atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD), to assess the effect on the concentration of the heart failure marker NT-proBNP.Materials and methods: the study included 120 patients who were divided in to 4 groups depending on the presence of CHF, AF and COPD. Patients underwent an echocardiographic (EchoCG) study, and the concentration of the N-terminal fragment of the brain natriuretic peptide precursor (NT-proBNP) was determined.Results: comparison of EchoCG parameters of the right heart in patients with CHF of different groups was performed in pairs to determine the effect of diseases on the remodeling of the right atrium (RA) and right ventricle (RV) in comorbid conditions. In patients with CHF, AF and COPD, in comparison with patients with CHF and AF without COPD, lower volume parameters of RA (p=0.004), greater wall thickness of the RV (p<0.001), lower values of the indexed end-diastolic area (EDA) of the RV (p=0.007) and its fractional area measurement (FAM) (p=0.011) were revealed, which allows us to judge the effect of chronic bronchoobstruction on heart remodeling in patients with CHF and AF. When compared with patients with CHF and COPD without AF in patients with CHF, AF and COPD have large size of RV (p=0.012), its indexed end-systolic area (ESA) (p<0.001), lower ejection fraction (EF) of RV (p=0.002), FAM (p<0.001), systolic excursion of the tricuspid valve plane (TAPSE) (p=0.012), indicating the influence of concomitant AF in EchoCG parameters in patients with CHF and COPD. A higher concentration of NT-proBNP was found in patients with CHF, AF and COPD compared to the marker level in both patients with CHF and AF without COPD (p=0.010) and in patients with CHF and COPD without AF (p<0.001), due to more pronounced remodeling of the RV.Conclusions: In patients with CHF, AF and COPD were the features of the remodeling of the right heart, caused by influence of, on the one hand, AF, on the other, with COPD the structural and functional parameters of heart in patients with this combined pathology. Using the extended protocol EchoCG studies identify additional characteristics of structural-functional state of the right heart (ESA and EDA RV, RV EF, TAPSE and FAM) will optimize early diagnosis of CHF and cardiovascular and bronchopulmonary diseases.
Highlights
Без хронической обструктивной болезни легких (ХОБЛ) выявлены более низкие объемные показатели правого предсердия (ПП) (р=0,004), большая толщина стенки правого желудочка (ПЖ) (р
Materials and methods: the study included 120 patients who were divided in to 4 groups depending on the presence of chronic heart failure (CHF), atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD)
With CHF of different groups was performed in pairs to determine the effect of diseases on the remodeling of the right atrium (RA) and right ventricle (RV) in comorbid conditions
Summary
Цель: выявить особенности структурно-функционального ремоделирования правых отделов сердца у пациентов с хронической сердечной недостаточностью (ХСН) на фоне сочетания фибрилляции предсердий (ФП) и хронической обструктивной болезни легких (ХОБЛ), оценить влияние на концентрацию маркера сердечной недостаточности NT-proBNP. Результаты: сравнение ЭхоКГ показателей правых отделов сердца у пациентов с ХСН разных групп проводили попарно для определения влияния заболеваний на ремоделирование правого предсердия (ПП) и правого желудочка (ПЖ) в условиях коморбидности. Использование расширенного протокола ЭхоКГ исследования с определением дополнительных показателей структурно-функционального состояния правых отделов сердца (КСП и КДП ПЖ, ФВ ПЖ, ФИП и TAPSE) позволит оптимизировать раннюю диагностику ХСН на фоне сердечно-сосудистых и бронхо-легочных заболеваний. Для цитирования: Чесникова А.И., Дзюрич Т.А., Сафроненко В.А., Терентьев В.П., Скаржинская Н.С., Годунко Е.С. Results: comparison of EchoCG parameters of the right heart in patients
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