Хроническая сердечная недостаточность различного генеза у больных хронической обструктивной болезнью легких

The aim of this study was to analyze prevalence, clinical course and pathogenesis of chronic heart failure (CHF) in patients with chronic obstructive pulmonary disease (COPD). Methods. The study involved 309 patients with COPD who underwent spirometry and Doppler echocardiography. Natriuretic peptide level was measured in blood. Results. One hundred and twelve (36.2%) patients had CHF. Patients with comorbidity were older, had higher body mass index, longer and more severe smoking history. Dyspnea as one of the main COPD symptoms existed for longer period in patients with COPD and CHF. CHF was related to severity of the airflow limitation. There was no difference between patients with different origin of CHF. The rate of hypertension was similar in COPD patients with and without CHF, but the duration of hypertension was almost twice as higher in patients with CHF. The left ventricular ejection fraction (LV EF) was significantly lower in COPD patients with CHF compared to those without CHF and was significantly lower in patients with ischaemic CHF compared to CHF of another origin. Also, COPD patients with CHF had significantly lower physical tolerance measured by 6-min walk test and more severe hypoxemia. Conclusion . Prevalence of CHF in COPD patients is quite high. CHF is caused both by concomitant cardiovascular disease (coronary heart disease, hypertension, etc.) and actually by progressive chronic cor pulmonale. Unaffected LV EF is seen more often in COPD patients; however, decreased LV EF is associated with coronary heart disease. Development of CHF in COPD patients is also associated with such risk factors as smoking, severe bronchial obstruction, hypoxemia, and tachycardia.