Professional chronic obstructive pulmonary disease in combination with heart failure - clinical and functional features
Introduction. Heart failure increases the severity of symptoms and worsens the prognosis of chronic obstructive pulmonary disease (COPD) in smokers. Professional COPD is a separate phenotype, which suggests differences in the pattern of comorbidity. Professional COPD in combination with heart failure has not been studied enough. The aim of the study was to determine the relationship of heart failure c clinical, functional and hygienic characteristics of professional COPD. Materials and methods. The one-center observational study included 115 patients with occupational chronic obstructive pulmonary disease (OCOPD). The comparison group of 103 patients with COPD, smokers of tobacco. The diagnosis of COPD met the criterion of GOLD 2011-2019. OCOPD patients were exposed to aromatic hydrocarbons with an excess of MPC in the air of working zone is 1.5 to 6 times, or of inorganic dust in the range of 2 to 9.5 MPC. Heart failure was diagnosed on the basis of any signs of myocardial dysfunction in echocardiography and/or elevation of the N-terminal precursor of cerebral natriuretic peptide (NT-pro-BNP) serum more than 125 PG/ml. the Groups were comparable in sex, age, duration of COPD, duration of action of exogenous etiological factor, causes of heart failure. Clinical and functional characteristics of COPD and heart failure were evaluated. For comparisons between groups for quantitative parameters used covariance analysis or test Kruskall-Wallis for comparison, the share of χ2 criterion. Relationships were determined by logistic regression. Results. In patients with OCOPD, the heart failure rate was higher - 63 (54.8%) cases compared to 38 (36.9%) in the group of COPD Smoking (p=0.009). Biventricular failure prevailed (44 (38.3%) patients) with preserved ejection fraction (47 (40.9%) cases). Right ventricular failure was detected in 15 (13.0%) of the subjects, left ventricular failure - in 4 (3.5%), p=0.002. Echocardiography revealed severe pulmonary hypertension and diastolic myocardial dysfunction in the OCOPD group. OCOPD in combination with heart failure was characterized by CAT index values of more than 10 points, low exercise tolerance, a significant rate of decline in FEV1, a decrease in the partial tension of arterial blood oxygen, severe exacerbations of COPD. In multivariate analysis of the development of heart failure in patients with OCOPD predicted: length of service, systolic pressure in the pulmonary artery, partial oxygen tension of arterial blood, the test distance of six-minute walk. Conclusions. 1. OCOPD is characterized by a probability of heart failure - 54.8%. Biventricular failure with preserved ejection fraction and predominant violation of diastolic myocardial function prevails. 2. The subphenotype of OCOPD in combination with heart failure is characterized by severe symptoms, hypoxemia of rest, severe exacerbations of COPD.