Peculiarities of Left Ventricular Remodeling in Arterial Hypertension Associated with Chronic Obstructive Pulmonary Disease

Kravchun P., Delevskaya V.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Introduction. сhronic obstructive pulmonary disease (COPD) is often associated with arterial hyper­ tension (AH), making background for chronic heart failure forming, which occurs more often in this combined pa­ thology than in single AH or COPD. Recently the substrate for heart failure is considered to be the remodeling of the heart and certain types of left ventricle remodeling are thought to be the predictors of high lethality in this pathology. Revealing types of heart remodeling in combined COPD and AH is under discussion. Objective of the study – to determine left ventricle geometry changes and diastolic function in patients with AH associated with COPD. Material and methods. Clinical examination of 38 patients with AH and COPD (25 men and 13 women) aged 68,7 ± 4,41 was carried out. The patients were divided into two groups. The first group included patients with AH and stage II COPD, the second one – with AH and stage III COPD. The comparing group consisted of patients with AH (18 patients). Almost healthy persons were taken as a control group (20 persons). All patients underwent standard clinical and laboratory methods of diagnostics. Systolic and diastolic function of left ventricle, its structural and morphological parameters were evaluated by echocardiography. Results and discussion. Changes of left ventricular geometry and diastolic dysfunction in all groups, compared to control, have been revealed. Left ventricle mass and left ventricle mass index was much higher in comorbidity group than in the control group and group of AH. у порівнянні з групою контролю відзначалося статистично достовірне збільшення (р < 0,05) ММ лШ та ІММ лШ при порівнянні з ізольованою аг (р < 0,05). Statistically comparable increase of end diastolic size, end systolic volume and end diastolic volume were noticed in groups of AH and different stages of COPD. Concentric left ventricular hypertrophy with insignificant wall thickening domi­ nated in patients with AH and combined AH and stage II COPD, eccentric and concentric left ventricular hypertrophy appeared with nearly similar occurence in coexistence of AH and stage III COPD. Various types of diastolic dysfunc­ tion were found in studied patients. Relaxation impairment type occurred predominantly in patients with AH and combined AH and stage II COPD, while patients with AH and stage III COPD appeared to have pseudonormalization type of diastolic dysfunction along with relaxation impairment type. End diastolic size, end diastolic volume and end systolic volume of left ventricle are increasing in progressing of bronchial obstruction and could be used for prog­ nosys of eccentric left ventricle hypertrophy forming in COPD with concomitant AH. Conclusions. Our data confirmed the presence of diastolic myocardial disfunction and left ventricular hyper­ trophy in patients with AH associated with COPD. Favourable conditions for functional disturbances development of central hemodynamics with consequent remodeling of left parts of the heart are being formed in COPD. This testifies to the influence of hypoxia and chronic inflamation on myocardial remodeling and reflects the worsening of cardio­vascular prognosis in studied patients. Fibrotic and antifibrotic factors affecting different types of left ven­ tricle remodeling are interesting to investigate.

arterial hypertension, chronic obstructive pulmonary disease, diastolic dysfunction, left ventricular hypertrophy, eccentric left ventricular hypertrophy

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