2016


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2016/№3

Regularities in development of chronic heart failure in patients with ischemic heart disease and chronic obstructive pulmonary disease associated with multiple comorbidity

Koziolova N. A., Masalkina O. V., Kozlova E. V.
State Budgetary Educational Institution of Higher Professional Education, “Academician E. A. Vagner Perm State Medical Academy” of the RF Ministry of Health Care, Petropavlovskaya 26, Perm 614000

Keywords: IHD, CHF, chronic obstructive pulmonary disease, comorbidity

DOI: 10.18087/rhfj.2016.3.2222

Background. Regularities and pathogenetic mechanisms in development of CHF associated with multiple cardiac and non-cardiac comorbidity remain understudied and controversial according to some reports. Aim. To determine regularities in development of CHF in patients with IHD and chronic obstructive pulmonary disease (COPD) associated with multiple comorbidity. Materials and methods. In consistency with inclusion and exclusion criteria 120 patients with IHD, AH and FC II-III CHF were divided into two equal groups and evaluate; group 1 contained patients with COPD and group 2 consisted of patients without bronchial obstruction. The groups were compared by cardiovascular risk factors, severity of AH, angina and CHF with evaluation of natriuretic peptide levels, and LV function. Results. CHF associated with IHD and COPD in combination with multiple comorbidity was characterized by greater severity than in patients without bronchial obstruction. This difference was evident as more pronounced decrease in exercise tolerance (p<0.001); more severe CHF FC (p=0.04); significantly higher values of mean diurnal (p=0.02) and mean daytime heart rate (p=0.038) and blood concentrations of NT-proBNP (p=0.012). In patients with IHD associated with COPD, CHF manifested itself primarily as impaired LV diastolic function with preserved LV EF and reduced indexed volumes of LV and left auricle (LA) in the absence of more pronounced pulmonary hypertension. Obesity, angina severity, BP, dyslipidemia, higher ventricular ectopic activity, and lower rate of prescribing ACE inhibitors and beta-adrenoblockers negatively contributed to develop­ment and progression of CHF associated with COPD. Conclusion. Development of CHF associated with COPD was related with definite RFs and comorbidity and determined by specific clinical and LV structural and functional changes, which required a special approach to selection of therapeutic interventions.
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Koziolova N. A., Masalkina O. V., Kozlova E. V. Regularities in development of chronic heart failure in patients with ischemic heart disease and chronic obstructive pulmonary disease associated with multiple comorbidity. Russian Heart Failure Journal. 2016;17 (3):151–163

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