Chronic Heart Research Articles

TCTAP C-110 Efficacy of Serial Balloon Pulmonary Angioplasty in Treating an Octogenarian with Severe Chronic Thromboembolic Pulmonary Hypertension and Right Heart Failure

TCTAP C-110 Efficacy of Serial Balloon Pulmonary Angioplasty in Treating an Octogenarian with Severe Chronic Thromboembolic Pulmonary Hypertension and Right Heart Failure

Bipolar transurethral enucleation of the prostate combined with open cystolithotomy in the treatment of large and giant prostate with bladder stones: Case series.

The surgical management of large or giant prostate still has challenges to urologists, especially if combined with bladder stones, and the traditional techniques by open prostatectomy and cystolithotomy have significant morbidity rates. The endoscopic procedure might not be feasible to treat both conditions in a single procedure, despite advances in surgical techniques and instrumentation, we present a one-session procedure by a combined endoscopic and open approach for treating benign prostatic hyperplasia (BPH) larger than 100 g combined with bladder stones in the elderly patient with other comorbidities. Between May 2017 and January 2020, bipolar transurethral plasma kinetic enucleation of the prostate (TUEP) followed by open cystolithotomy was performed to six patients at our institution, three of them combined with a big bladder stone(s). All the patients have other chronic chest and heart diseases; we retrospectively collected the data. All the patients diagnosed as BPH of big size or giant prostate over 100 g, with bladder stone, and all the patients treated with the same procedure. We founded that the combination methods showed a significant effect in terms of surgery time, patient outcomes and recovery, hospital discharge. The mean age of patients was 78.16 ± 4.2 (73-84) years, and the mean prostate-specific antigen (PSA) value was 16.27 ± 10.01 (8.32-32.17) ng/mL. The mean size of the prostate measured by MRI/US was 266.16 ± 89.1 (169-405) mL. The mean total operation time was 70.5 ± 10.9 (60-90) min, while the mean enucleation time was 28.38 ± 6.61 (23-40) min. The mean intraoperative blood loss was 193.33 ± 19.66 (170-220) mL. The mean resected prostate weight was 217.166 ± 94.67 (117-365) g. The mean post-operative hospital stay was 2.6 ± 0.81 (2-4) days. One patient was readmitted 2 months later due to urinary tract infection, and one patient complains of urine incontinence who spontaneously subsided in 4 months after surgery, other that no severe postoperative complications observed, a significant reduction of serum PSA and IPSS recorded at 3 months, postoperatively. Although simple open prostatectomy remains the reference standard for the treatment. Of excessively large or giant prostatic hyperplasia, the combination procedure not only facilitates the management of selected cases of hyperplasia but further imparts significant benefits to patients and surgeons alike. This treatment plan is safe, time-consuming, and could revolutionize future treatment approaches to giant prostate.

Association of cytomegalovirus diseases with newly developed myocardial infarction and congestive heart failure: data from a national population-based cohort.

IntroductionAnti-cytomegalovirus (CMV) IgG seropositive and/or titer are associated with a higher risk of cardiovascular diseases (CVD). However, it is not clear whether CMV end-organ disease may have a relation with development of CVD or chronic heart diseases.Material and methodsIn matched cohort study, the National Health Insurance Database covering 50 million people was used to identify 667 patients with CMV diseases and aged ≥ 20 years between 2010 and 2014. 6,670 control subjects without CMV diseases were matched by age, sex, type 2 diabetes mellitus (DM), hypertension, dyslipidemia, and cohort entry year. Data on CMV disease and heart disease events of myocardial infarction (MI), congestive heart failure (CHF), and atrial fibrillation (AF) were retrieved. Previous events before CMV disease or cohort entry were excluded until January 2006. Subjects were followed until December 2015 in subjects without events and until date of events in subjects with events.ResultsThe multivariate regression model adjusted by age, sex, low-income status, type 2 DM, hypertension, dyslipidemia, solid organ transplantation, and hematopoietic stem cell transplantation showed a significantly higher incidence rate of MI (odds ratio (OR) = 2.1, 95% confidence intervals (CI): 1.0–4.5) and CHF (OR = 3.8, 95% CI: 2.1–6.8) but not AF (OR = 1.9, 95% CI: 0.9–4.0) in patients with CMV disease. The age group of 40–64 years with CMV disease had the highest risk for new-onset CHF in this regression model (OR = 9.4, 95% CI: 4.12–21.44, p = 0.029).ConclusionsSymptomatic CMV tissue-invasive diseases were associated with a higher risk of new-onset MI and CHF.

Platelet reactivity in patients with coronary artery disease on treatment with ivabradine and clopidogrel: The PLATIVA study

The combination of aspirin and clopidogrel remains the most frequent dual antiplatelet therapy in patients with acute coronary syndrome or undergoing percutaneous coronary intervention. Clopidogrel, a P2Y12 adenosine diphosphate (ADP) platelet receptor inhibitor requires transformation by cytochrome P450 (CYP) in the liver to produce an active metabolite. On the other hand, ivabradine is an effective antianginal drug that is also metabolized by the CYP enzyme, acting as a weak inhibitor. Our aim is to evaluate the impact of ivabradine on platelet reactivity in patients receiving clopidogrel and to evaluate the possible pharmacodynamic interactions between them. This is a prospective, observational, post-authorization pharmacodynamic study including patients treated with aspirin and clopidogrel and initiating ivabradine. Patients with platelet abnormalities and those treated with anticoagulants or other CYP inhibitors were excluded. A platelet aggregation test was performed at baseline before the first dose of ivabradine and repeated after 4 weeks of treatment. The primary endpoint was inhibition of platelet aggregation (IPA) after 20 mM ADP stimulation. A total of 34 patients were initially recruited; eight patients were excluded, leaving 25 patients for final analysis. All patients had chronic ischemic heart disease. The maximum ivabradine dosage of 7.5 mg twice daily was achieved in seven patients (28%). After 4 weeks of treatment with ivabradine, no significant differences were found in maximal platelet aggregation from baseline, as assessed with 20 μM ADP stimulation. In addition, no significant difference in IPA from baseline was detected after stimulation with ADP 5 μM, arachidonic acid, thrombin receptor-activated peptide 25 μM, and platelet reactivity index. Ivabradine did not alter antiplatelet response to clopidogrel in patients treated concomitantly with both drugs.

A semi-mechanistic exposure\u2013response model to assess the effects of verinurad, a potent URAT1 inhibitor, on serum and urine uric acid in patients with hyperuricemia-associated diseases

Verinurad, a uric acid transporter 1 (URAT1) inhibitor, lowers serum uric acid by promoting its urinary excretion. Co-administration with a xanthine oxidase inhibitor (XOI) to simultaneously reduce uric acid production rate reduces the potential for renal tubular precipitation of uric acid, which can lead to acute kidney injury. The combination is currently in development for chronic kidney disease and heart failure. The aim of this work was to apply and extend a previously developed semi-mechanistic exposure–response model for uric acid kinetics to include between-subject variability to verinurad and its combinations with XOIs, and to provide predictions to support future treatment strategies. The model was developed using data from 12 clinical studies from a total of 434 individuals, including healthy volunteers, patients with hyperuricemia, and renally impaired subjects. The model described the data well, taking into account the impact of various patient characteristics such as renal function, baseline fractional excretion of uric acid, and race. The potencies (EC50s) of verinurad (reducing uric acid reuptake), febuxostat (reducing uric acid production), and oxypurinol (reducing uric acid production) were: 29, 128, and 13,030 ng/mL, respectively. For verinurad, symptomatic hyperuricemic (gout) subjects showed a higher EC50 compared with healthy volunteers (37 ng/mL versus 29 ng/mL); while no significant difference was found for asymptomatic hyperuricemic patients. Simulations based on the uric acid model were performed to assess dose–response of verinurad in combination with XOI, and to investigate the impact of covariates. The simulations demonstrated application of the model to support dose selection for verinurad.

Less is more in cardiology and angiology

Cardiovascular medicine is one of the most resource-consuming parts of the healthcare system and many examples of overdiagnostic and overtreatment can be found. The present article presents just three of these, one from cardiology and two from vascular medicine. The topic of chronic coronary heart disease concerns the unequivocal proof of ischemia before a coronary intervention. The sections on Duplex sonography of the cervical blood vessels and the diagnostics of thrombophilia describe which valid clinical problems may justify the performance of these examinations at all. The potential for harm caused by overdiagnostics in both cases lies not only in the unnecessary use of resources but, more importantly, in the subsequent overtreatment. The few appropriate indications are described in detail.

The state of the cardiovascular system in occupational bronchitis and chronic obstructive pulmonary disease, not associated with the impact of harmful industrial factors

The formation and progression of chronic dust bronchitis and chronic bronchitis of toxic-chemical etiology, chronic obstructive pulmonary disease is accompanied by an increase in the degree of ventilation disorders, echocardiographic signs of hypertrophy and dilatation of the right ventricle are formed, typical for chronic pulmonary heart disease. The progression of disturbances in the function of external respiration in dusty lung diseases leads to a decrease in myocardial contractility. The detection of hemodynamic disturbances at the early stages of the development of occupational lung diseases indicates the need for individual monitoring of the functional state of the cardiovascular system in the process of contact with industrial aerosols, especially in groups of workers with long-term exposure.

Abstract P716: Factors Associated With Functional Dependence at Hospital Discharge in Patients With Low NIHSS Strokes Who Do Not Receive Intravenous Alteplase

Introduction: Patients without prior functional deficits who suffer mild stroke (NIHSS <6) have a 20-30% likelihood of disability (mRS ≥2). Predictors of disability have been described mostly in clinical trials and single center registries. We identified variables associated with functional dependence (mRS ≥3) in mild stroke using a retrospective population-based sample. Methods: Hospitalized strokes from the Greater Cincinnati Northern Kentucky Stroke Study were used. Included patients had an initial NIHSS <6 and baseline mRS 0, both extrapolated from chart review. To minimize the inclusion of patients with disabling symptoms, tPA treatment was excluded. Demographic and clinical characteristics were analyzed by discharge disability status. A multivariable logistic model with least absolute shrinkage and selection operator (lasso) regression analysis identified independent predictors of disability. Results: Of 1268 ischemic strokes, 353 (28%) were functionally dependent at discharge. Increased baseline NIHSS was associated with worse outcome on the mRS. Leg, LOC questions, and sensation NIHSS subscores were the best predictors of outcome. Multivariable analysis identified age, race, hypertension, chronic kidney disease, heart failure, and post-stroke dysphagia as independently associated with discharge mRS ≥3. Discussion: Our results agree with and complement the results of prior studies. They are not limited by inclusion/exclusion criteria or referral bias. Rather, our major limitation is the retrospective estimation of NIHSS and mRS based on physician descriptive documentation rather than direct score assessment. Our results may allow for modeling to better predict outcome which in turn can inform clinical decision making and trial design.

FORMATION, ASSESSMENT AND CORRECTION OF COGNITIVE DISORDERS IN PATIENTS WITH COMORBID CHRONIC OBSTRUCTIVE PULMONARY AND CORONARY HEART DISEASES

Chronic obstructive pulmonary disease is an important health, social and economic issue. It is one of the leading morbidity and mortality causes worldwide. Comorbid pathology of chronic obstructive pulmonary and coronary heart diseases occurs quite often. For the patients over 60 years, the frequency of their combination directly depends on age due to common pathogenetic mechanisms (oxidative stress, endothelial dysfunction, systemic inflammation, etc.). Often these diseases are accompanied with cognitive disorders. Impaired memory and other cognitive functions significantly reduce the quality of life of the patients, negatively affect professional activities, reduce the ability to learn, reduce compliance with therapy, complicate psychological contact with the physician, and worsen the lives of relatives. But there is still no common clear understanding of many aspects of the development of cognitive disorders, their mechanisms in chronic obstructive pulmonary disease in combination with coronary heart disease. Therefore, there is no single standard method to treat such patients. In addition to medications (vasoactive and neurotropic drugs), alternative methods are used to treat cognitive disorders, namely these are special exercises to train memory and attention (cognitive training). Methods aimed at increasing the patient's motivation, learning effective memorization strategies, training the ability to maintain a long−term concentration, active involvement of emotional support and imagination are relevant. The use of available non−drug methods, dosed exercise and proper nutrition can reduce the severity of cognitive disorders and thereby improve the quality of life of the patients and their immediate environment. Key words: chronic obstructive pulmonary disease, coronary heart disease, comorbidity, cognitive disorders

Rate of use and effectiveness of oseltamivir in the treatment of influenza illness in high-risk populations: A systematic review and meta-analysis.

BackgroundOseltamivir is recommended in the treatment of influenza illness in high‐risk populations, including those with chronic heart and lung diseases.ObjectivesWe conducted a systematic review and meta‐analysis to determine the rate of use and effectiveness of oseltamivir in these groups of patients.MethodsThe protocol for the systematic review was registered on PROSPERO (CRD42019125998). Medline, EMBASE, Cochrane CENTRAL, and CINAHL were searched for observational studies and randomized controlled trials published up to 16 February 2020. Quality appraisal of final studies was conducted using GRADE guidelines. Data were extracted using a predeveloped template. Main outcomes measured included the rate of use of oseltamivir for influenza‐like‐illness and its effectiveness in reducing disease severity in patients with cardiopulmonary diseases. Outcomes measured for effectiveness were influenza‐related complications (respiratory infections and asthma exacerbations), hospitalization rates, and time to freedom from illness. Risk of bias was assessed using Cochrane's Risk of Bias 2.0 tool for randomized trials and Cochrane's Risk of Bias in nonrandomized Studies of Interventions tool for nonrandomized trials. Where data were available, pooled analyses were conducted. Dichotomous variables were evaluated using the Mantel‐Hansel method. A random effect model was applied. Summary measures were reported as risk ratios where relevant.ResultsOur systematic review identified nine studies. Oseltamivir use ranged from 25% to 100%. When oseltamivir group was compared to placebo, rates of respiratory tract infections reduced by 28% (RR = 0.72, 95% CI = 0.59‐0.90), hospitalization reduced by 52% (RR = 0.48, 95% CI = 0.28‐0.80) and median time to illness alleviation decreased by 10.4 to 120 hours. There was no significant reduction in asthma exacerbation rates.ConclusionsOur systematic review suggests that the use of oseltamivir is beneficial in reducing disease severity, however, its use in high‐risk population remains suboptimal.

QT dispersion in patients with chronic and advanced heart failure: Is it only a methodological problem?

QT dispersion in patients with chronic and advanced heart failure: Is it only a methodological problem?

Pulmonary Hypertension in Acute and Chronic High Altitude Maladaptation Disorders.

Alveolar hypoxia is the most prominent feature of high altitude environment with well-known consequences for the cardio-pulmonary system, including development of pulmonary hypertension. Pulmonary hypertension due to an exaggerated hypoxic pulmonary vasoconstriction contributes to high altitude pulmonary edema (HAPE), a life-threatening disorder, occurring at high altitudes in non-acclimatized healthy individuals. Despite a strong physiologic rationale for using vasodilators for prevention and treatment of HAPE, no systematic studies of their efficacy have been conducted to date. Calcium-channel blockers are currently recommended for drug prophylaxis in high-risk individuals with a clear history of recurrent HAPE based on the extensive clinical experience with nifedipine in HAPE prevention in susceptible individuals. Chronic exposure to hypoxia induces pulmonary vascular remodeling and development of pulmonary hypertension, which places an increased pressure load on the right ventricle leading to right heart failure. Further, pulmonary hypertension along with excessive erythrocytosis may complicate chronic mountain sickness, another high altitude maladaptation disorder. Importantly, other causes than hypoxia may potentially underlie and/or contribute to pulmonary hypertension at high altitude, such as chronic heart and lung diseases, thrombotic or embolic diseases. Extensive clinical experience with drugs in patients with pulmonary arterial hypertension suggests their potential for treatment of high altitude pulmonary hypertension. Small studies have demonstrated their efficacy in reducing pulmonary artery pressure in high altitude residents. However, no drugs have been approved to date for the therapy of chronic high altitude pulmonary hypertension. This work provides a literature review on the role of pulmonary hypertension in the pathogenesis of acute and chronic high altitude maladaptation disorders and summarizes current knowledge regarding potential treatment options.

Prevalence of multiple risk factors for poor outcomes associated with COVID-19 among an elderly Australian population.

Increasing age, male sex and various chronic conditions have been identified as important risk factors for poor outcomes from COVID-19. The aim of this study was to examine the prevalence of risk factors for poor outcomes due to COVID-19 infection in an older population. The proportion of the population with one or more risk factors and the prevalence of individual risk factors and multiple risk factors were calculated among Department of Veterans' Affairs (DVA)clients aged ≥70 years. There were 103,422 DVA clients included. Of these, 79% in the community and 82% in residential aged care had at least one risk factor for poor outcomes from COVID-19. Hypertension was most prevalent, followed by chronic heart and airways disease. Over half had ≥2 risk factors, and one in five had ≥3 risk factors across multiple body systems. A substantial proportion of older Australians are at risk of poor outcomes from COVID-19 because of their multimorbid risk profile. These patients should be prioritised for proactive monitoring to avoid unintentional harm due to potential omission of care during the pandemic.

Removing Fuel from Coronavirus Fire: Blocking Superoxide through NOX Inhibition

Background: The toll of the coronavirus pandemic needs little introduction. The commencement of vaccination is both impressive and welcome but insufficient to achieve herd immunity. Consequently, additional approaches are urgently needed for pandemic abatement.Hypothesis: Inhibiting the human NADPH oxidase enzyme can reduce the morbidly and mortality of severe coronavirus infection by preventing excess production of superoxide free radicals, the reason behind severe infection. This can be accomplished with apocynin, a historic natural well-researched compound, and its derivative paeonol, present in the readily available peony root.Evidence: The common denominator of who dies from coronavirus (the aged, males, post-menopausal females, African Americans, obesity, diabetics, hypertensives, chronic heart, liver, kidney disease patients) is oxidative stress. Moreover, the source can be traced specifically to a higher endogenous production of the reactive oxygen species superoxide from NADPH-oxidase activity shared by these groups. In addition, interventions for coronavirus infection that act on the host (Vitamins C, D, B3, melatonin, estrogen, nicotine) all decrease NADPH oxidase activity even when not the stated reason for use. Finally, apocynin’s well-studied use as a highly effective NADPH inhibitor is covered. Implications: The direct implication is reduction in serious infections and deaths. especially in COVID-vulnerable groups. Apocynin may also be capable of targeting other lethal viruses that co-evolved with bats in the same oxygen-rich milieu, such as Ebola. An intriguing potential application is in Chronic Fatigue Syndrome, Mast Cell Activation Syndrome, and dysautonomia, all with symptoms resembling the COVID long-hauler syndrome. Finally, as the role of NADPH oxidase in conditions of aging such as cardiovascular disease and neurodegeneration is being increasingly recognized, apocynin as “vitamin of the 21st century” for longevity warrants investigation.Conclusion: Oxidative bursts kill pathogens but can be exploited by viruses to replicate. By removing this fuel from coronavirus fire, apocynin and peony root are safe available compounds dating to antiquity that become attractive contenders for rapid pandemic relief.

Challenges for Adolescents With Congenital Heart Defects/Chronic Rheumatic Heart Disease and What They Need: Perspectives From Patients, Parents and Health Care Providers at the Institut Jantung Negara (National Heart Institute), Malaysia.

ObjectivesThis study aimed to describe the experiences and challenges faced by adolescents with moderate and severe congenital heart defects (CHD) or Chronic Rheumatic Heart Disease (CRHD) and to determine their needs in order to develop an Adolescent Transition Psychoeducational Program.MethodsThe study involved seven adolescents with moderate to severe CHD/CRHD, six parents, and four health care providers in Institute Jantung Negara (National Heart Institute). Participants were invited for a semi-structured interview. Qualitative data were analyzed through the Atlas.ti 7 program using triangulation methods.Results/conclusionsWe identified five themes concerning the experience and challenges of adolescents relating to: (1) emotional/psychological issues; (2) the progress of the illness; (3) relationship issues; (4) future preparation; and, (5) school and community. These themes were identified together with eleven subcategories. The staff expressed support for the development of the Adolescent Transition Psychoeducational Program and adolescents with CHD/CRHD and their parents were willing to participate in the program if their schedule allowed. Their suggestions to improve the program were classified into six categories, with two main themes, (1) the self-management of illness in life and the future; and, (2) social support. In conclusion, the findings from the situation analysis act as a basis for a conceptual framework that will contribute to the development of an Adolescent Transition Psychoeducational Program that aims to empower adolescents with CHD/CRHD, enabling them to manage challenges during the transition phase between childhood and adulthood.

Chiari I malformation with Klippel-Trenaunay syndrome: case report and review of the literature

We present a rare case of an 8-year-old male with Klippel-Trenaunay syndrome (KTS) and a Chiari I malformation (CIM). Magnetic resonance imaging (MRI) to investigate facial asymmetry and speech delay at age two revealed CIM with cerebellar tonsils 1.3 cm below the foramen magnum without syringomyelia. The patient underwent a craniectomy and posterior fossa decompression with C1 laminectomy. While gene sequencing determined the patient was negative for the PIK3CA gene mutation, the patient’s clinical history strongly suggests KTS. He has hemihypertrophy, leg length discrepancy, hemangiomas and pigmentary mosaicism along the upper and lower extremities, heart murmur, chronic low heart rate, recurrent hip pain, and mild scoliosis. Neurodevelopmental concerns include difficulty reading, attention deficit hyperactivity disorder (ADHD), anxiety, and difficulty running and going downstairs. His most recent MRI shows good decompression at the cervicomedullary junction, global cerebrospinal fluid (CSF) flow, and less peg-like cerebellar tonsils. Also noted were two intravertebral hemangiomas at T5 and T6. While the patient’s speech has improved, there is still difficulty with the expressive language. He still has mild delays, runs slowly, and does not alternate feet when climbing stairs. The patient is being followed by multiple specialists including neurology, hematology-oncology, genetics, orthopedic surgery, and developmental pediatrics.

A rare gastric polyp: MANET

A 79-year-old woman with a medical history of type 2 diabetes, hypertension, and chronic heart and kidney failure was admitted to the hospital because of cholangitis. She underwent ERCP, which incidentally showed a 25 × 10 mm pedunculated polyp with eroded tip located on the greater gastric curvature (Paris endoscopic classification of polyps 0-Ip) (A, B). Subsequent gastroscopy showed atrophic antral gastritis. The polyp was electroresected. Histologic analysis indentified a mixed neuroendocrine-noneuroendocrine neoplasm (MiNEN) composed of neuroendocrine tumor and tubular adenoma (MANET), with growth in the deeper part of the mucosa and submucosa.

Effects of Sports Rehabilitation Nursing Combined with Comfortable Intervention on Cardiac Function for Patients with Chronic Congestive Heart Failure

Effects of Sports Rehabilitation Nursing Combined with Comfortable Intervention on Cardiac Function for Patients with Chronic Congestive Heart Failure

Epidemioclinics, Etiologies and Prognosis of Cardiogene Shock State in the Intensive Care Unit of the Cardiology Department of the G-Spot Hospital

Objective: The work aimed to describe the etiological and evolutionary aspects of cardiogenic shock in the intensive care unit of the cardiology department (USIC) of the G-spot hospital in Bamako, Mali. Materials and Methods: This was a descriptive cross-sectional study from January 1, 2018 to April 30, 2019 that included all patients admitted to the USIC during this period. Each patient benefited from individual data support with systematic recording of socio-demographic, clinical, complementary and therapeutic data and analyzed with the SOFTWARE SPSS 20.0 French version. Results: The study involved 40 patients out of 311 patients hospitalized in USIC, representing a hospital frequency of 12.86%. Males were the most affected (60%) with a sex ratio of 1.50. The modal class was 41 - 60 years with extremes at 18 years and 89 years. Cardiovascular risk factors were dominated by HTA (27.50%), diabetes and tobacco, each with 22.50%. The general signs were tachycardia (90%), oxygen desaturation (77.50%), impregnable blood pressure (62.50%), agitation (52.50%) and an oliguria (70%). At the electrocardiogram the rhythm was sinus (80%), it was an atrial fibrillation (15%), a ventricular tachycardia (10%) and signs of coronary ischemia (necrosis in 35% and ST over shifted in 20% of cases). At cardiac doppler ultrasound,the left ventricle was dilated (50%), the right cavities dilated (30%), segmental kinetic disorder (40%), the left ventricular systolic function (FEVG) impaired (75%) and valve disease (10%). Biology noted hyper-creatinemia (65%), hyper-glycemia (12.50%), anemia and hyponatremia with 20% frequency each. Among etiology, ischemic heart disease accounted for 57.50% followed by pulmonary embolism 20%, dilated valve cardiomyopathy 7.50% and chronic pulmonary heart 2.50%. The trend in the majority of cases was unfavorable with 60% of deaths. Chronic pulmonary heart and pulmonary embolism were the deadliest with a frequency of 100% and 87.50% respectively. Conclusion: Cardiogenic shock is an infrequent condition with a high mortality of a prognosis. Ischemic heart disease is the most common etiology of the disease.

Легочно-сердечная гемодинамика у больных ХОБЛ и муковисцидозом по данным эходопплеркардиографии

Aim: to assess the functionality of the right heart in patients with chronic obstructive pulmonary disease (COPD), mixed cystic fibrosis (CF), and cystic fibrosis lung disease by Doppler echocardiography. Patients and Methods: 30 adults with CF and 82 adults with COPD underwent ultrasonography to evaluate pulmonary and cardiac hemodynamics. All patients were divided into four groups based on the presence/absence of clinical signs of right ventricular failure and pulmonary hypertension. Results: in COPD, diastolic dysfunction of the right heart can be subclinical preceding systolic impairment. Right ventricular hypertrophy and failure in CF occur in relatively low pulmonary artery pressure. Thus, in systolic pulmonary pressure less than 40–50 mm Hg, hypertrophy and dilation were concomitant. As the diastolic function of the right ventricle worsens, right atrial contractility increases while the ratio of left ventricular filling velocities during the early atrial diastole and systole reduces in patients with CF. Conclusion: in severe COPD, significant structural and functional impairments of the right ventricle occur. Compensatory potentialities of the right and left ventricles exhaust, thereby providing the conditions for the progression of heart failure and the development of the chronic pulmonary heart. In CF, diastolic dysfunction of the right heart often precedes systolic dysfunction, as illustrated by changes in the proportion of various filling phases of the right ventricle. In right ventricular diastolic dysfunction, an increase in right atrial contractility occurs that reduces only in severe decompensation of the chronic pulmonary heart. KEYWORDS: chronic obstructive pulmonary disease, cystic fibrosis, echocardiography, Doppler cardiography, pulmonary hypertension, right ventricular failure, diastolic function. FOR CITATION: Titova O.N., Kuzubova N.A., Aleksandrov A.L. et al. Pulmonary and cardiac hemodynamics in COPD and cystic fibrosis by Doppler echocardiography. Russian Medical Inquiry. 2021;5(7):456–461 (in Russ.). DOI: 10.32364/2587-6821-2021-5-7-456-461.