Open AccessClinical and functional cardiovascular disorders in patients with chronic obstructive pulmonary disease and chronic heart failure
Author(s) -
Ya. N. Shoikhet,
Elena Klester
Publication year - 2008
Publication title -
pulʹmonologiâ
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.126
H-Index - 6
eISSN - 2541-9617
pISSN - 0869-0189
DOI - 10.18093/0869-0189-2008-0-2-62-67
Subject(s) - medicine , copd , heart failure , cardiology , angina , pulmonary disease , pulmonary function testing , pulmonary heart disease , concomitant , stage (stratigraphy) , myocardial infarction , paleontology , biology
The study was aimed to investigate clinical and functional particularities of cardiovascular system in patients with COPD and chronic heart failure (CHF). We examined 1737 patients, of them, 498 with COPD (the 1st group), 721 with COPD and concomitant class I to III stable angina (the 2nd group), and 519 with class I to III stable angina (the 3rd group). All the patients also had CHF. The study included clinical assessment using modified R. Cody's scale, ECG, Holter monitoring, lung function testing, Doppler echocardiography, 6-minute walk test (6MWT). Obstructive disorders were found in 424 of the 2nd group patients (58.8 %) and 268 of the 3rd group patients (51.7 %). Number of patients with class II to IV chronic cor pulmonale was similar in all groups. The class III was determined more often in the 2nd group (36.5 %; р < 0.05), the class I prevailed in the 1st group (17.8 %; р < 0.05). The stage I CHF predominated in the 1st group (31.9 %; р < 0.05), the stages IIА and IIБ were seen mainly in the 2nd group (51.6 % and 26.4 % respectively; р < 0.05). The majority of the 3rd group patients (57.3 %) had the stage IIA CHF. According to most clinical signs, CHF was more severe in the 2nd group. 6MWT was 308.08 ± 6.03 m in the 1st group, 156.4 ± 4.38 m in the 2nd group, and 212.8 ± 5.65 m in the 3rd group (р < 0.05). Low left ventricular (LV) ejection fraction was seen significantly more often in COPD patients with concomitant angina. This group as well as COPD patients had significantly higher mean pulmonary artery pressure (mPAP) (24.7 ± 0.41 mm Hg and 29.9 ± 0.27 mm Hg respectively) compared to 21.7 ± 0.07 mm Hg in the 3rd group patients. Right ventricular (RV) diastolic dysfunction was revealed in 154 patients of the 1st group (83.7 %), 194 patients of the 2nd group (91.9 %) and 72 patients of the 3rd group (43.1 %). In conclusion, all the patients had RV and LV remodeling signs. COPD patients had more prominent RV hypertrophy and dilation, angina patients had enlargement of left heart and moderate decrease in LV contractility. The patients with COPD and angina had the greatest increase in size and wall thickness of both LV and RV and low pump function of LV.