Clinical characteristics of the respiratory and cardiovascular systems in patients with combination of chronic obstructive pulmonary disease and heart failure

• Main Authors: I. I. Vyshnyvetskyy, L. S. Kholopov, V. O. Batashova-Halynska
• Format: Article
• Language: English
• Published: Zaporozhye State Medical University 2017-06-01
• Series: Zaporožskij Medicinskij Žurnal
• Subjects: heart failure; chronic obstructive pulmonary disease; comorbidity
• Online Access: http://zmj.zsmu.edu.ua/article/view/100572/97145
• ISSN: 2306-4145; 2310-1210

The aim of our work was to assess the respiratory and cardiovascular systems of patients with a combination of chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF). Materials and methods. The study included 177 patients who had been diagnosed COPD by criteria GOLD. CHF was diagnosed in 77 (43.5 %) cases – 29 (16.4 %) with reduced systolic function and 48 (27.1 %) with preserved systolic function. We analyzed some important parameters characterizing respiratory and cardiovascular systems. We tried to identify statistically significant difference of parameters between patients with COPD and those with COPD and CHF. Moreover, patients with CHF were evaluated as a whole, and separately with reduced and with preserved systolic function. Results. Thus, we observed significant deterioration in general clinical, laboratory, spirometric and echocardiographic parameters depending on the presence and severity of CHF in patients with COPD. In particular, the presence of CHF, especially with impaired systolic function significantly impair indicators such as incidence of cardiac arrhythmias and signs of ischemia on the ECG, NT-proBNP levels, prevalence of concentric, eccentric hypertrophy and concentric LV remodeling and diastolic dysfunction type "relaxation disorder", and incidence of a-wave absence during assessment of motion of the rear pulmonary artery valve wall. Listed changes as well as some of the tendencies that have not reached a certain level of significance, indicate that patients with COPD and concomitant CHF, especially with impaired systolic function, worsens general clinical parameters (breath rate, systolic blood pressure, heart rate, frequency arrhythmias and myocardial ischemia on ECG); laboratory levels of hemoglobin, hematocrit, cholesterol, glomerular filtration rate; spirometric indicators of bronchial obstruction (FEV1, FVC, instant volume expiratory flow rates); echocardiographic indicators suggest the deterioration of the heart geometry (increasing of myocardial mass index, indexes of LV end-systolic and end-diastolic volumes, increased frequency of all variants of LV pathological remodeling detection, RV wall thickness, the ratio of RV/LV) diastolic function impairment (increased frequency of all types diastolic dysfunction detection); development of pulmonary hypertension (increasing of the maximum flow velocity, pressure gradient, and the systolic pressure in the pulmonary artery, the frequency of detection of the absence of a-wave). Conclusions. The presence of heart failure in patients with COPD worsens important clinical, laboratory and instrumental parameters of the cardiovascular and respiratory systems.