The pathological reactions of brachial artery during and their significance in treatment of patients with chronic obstructive pulmonary disease

Abstract

Background. The purpose of this study was to analyse the pathological reactions of brachial artery (BA) during test with reactive hyperemia (RH) for endothelial function (EF) estimation and their applicable significance in treatment of patients with chronic obstructive pulmonary disease (COPD). Material and methods. There were investigated 61 patients, mean age 47,7±5,11 years with moderate to severe forms of COPD (by GOLD criterion). Endothelial dysfunction (ED) estimation was performed non-invasive, using probe with RH with brachycephalic arteries Duplex with high resolution 8,0-10,0 MHz („Logiq S8” „General Electric”, SUA) by David S. Celermajer proposed method. ED was considered when EF index was less than 10%. Results. The analysis of obtained data revealed considerable decreasing of EF: mean EF index was 7,14±11,22%, between -15,0% and 29,4%. In 10 patients after RH test was noted pathological reaction of BA: instead of awaited endothelialdependent BA dilatation, there were observed spastic and negative reactions (in limits between 0% and −15,0%). In parallel there were visualized in a. carotis solitary and binary atherosclerotic plagues with 20-40% of vascular stenosis without any clinical manifestations. The levels of total cholesterol and LDL-C also were elevated: 7,5±2,0 mm/l и 4,7±1,8 mm/l, respectively. In all 10 patients with pathological BA reactions do not reduced mean and systolic pulmonary artery pressure after 5 weeks of treatment with perindopril (mean dose 2,9±1,5 mg once daily) or valsartan (mean dose 54,5±15,4 mg once daily). Conclusions. Thus, BA pathological reaction during RH test for ED estimation may be used like a criterion predictor of efficacity of treatment with perindopril or valsartan and for prognosis of survival in patients with severe forms of COPD.