2017

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2017/№3

Contribution of chronic obstructive pulmonary disease to remodeling of target organs in patients with arterial hypertension and ischemic heart disease associated with chronic heart failure

Koziolova N. A., Masalkina O. V., Kozlova E. V., Surovtseva M. V.
Federal State Budgetary Educational Institution of Higher Education, "Academician E. A. Vagner Perm State Medical University" of the Ministry of Health of the Russian Federation, Petropavlovskaya 26, Perm 614000

Keywords: chronic heart failure, chronic obstructive pulmonary disease

DOI: 10.18087/rhfj.2017.3.2354

Background. High prevalence of chronic obstructive pulmonary disease (COPD) among patients with cardiovascular diseases, common features of their pathogenetic mechanisms, and the negative influence on prognosis of the disease predetermine the interest to remodeling of target organs in patients with chronic heart failure (CHF) associated with AH and IHD in combination with bronchial obstruction. Aim. To determine specific features of the development and the structural and functional remodeling of kidneys and arterial vasculature in patients with AH and IHD associated with CHF and COPD. Materials and methods. Based on inclusion and exclusion criteria 120 patients with IHD, AH and FC II-III CHF were evaluated and divided into two equal groups: group 1, patients with COPD and group 2, patients without bronchial obstruction. Parameters reflecting features of CHF development and structural and functional status of arteries and kidneys were compared between group. Results. In patients with AH and IHD associated with CHF, presence of COPD was related with development of more pronounced LV diastolic dysfunction (p=0.027 by E/A) with preserved EF and a higher level of N-terminal fragment of natriuretic peptide (p=0.012). More severe disturbance of kidney filtration function (p=0.027 by cystatin C), more pronounced genuine arterial stiffness (p<0.001 by CAVI1 index) at increased TIMP-1 (p=0.045) and surfactant А (p<0.001) levels were observed in patients with cardiac pathology and COPD. Conclusion. More severe CHF with preserved LV EF develops in the presence of COPD. In patients with AH and IHD complicated with CHF, remodeling of target organs in bronchial obstruction was characterized with specific changes in the structural and functional status of arterial vasculature and kidneys. One mechanism of these changes is shifting the balance of collagenolytic processes towards fibrosis.
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Koziolova N. A., Masalkina O. V., Kozlova E. V., Surovtseva M. V. Contribution of chronic obstructive pulmonary disease to remodeling of target organs in patients with arterial hypertension and ischemic heart disease associated with chronic heart failure. Russian Heart Failure Journal. 2017;18(3):201–207

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