Репозиторий Университета

© 2018 Media Sphera Publishing Group.All right reserved. Aim: to assess the state of vascular bed, parenchyma, and perfusion of lungs in patients with chronic thromboembolic pulmonary hypertension (CTEPH) using the method of subtraction computed tomography (CT). Methods. CT pulmonary angiography (CTPA) was performed in 45 patients with verified CTEPH (18 men, 27 women, age 26-79 years) by CT scanner using the "Lung subtraction" standard protocol. Parameters analyzed were characteristics of the state of main pulmonary artery (MPA) and the right ventricle (RV), and calculated CT angiographic (CTA) obstruction and perfusion defect scores. Results. Significant correlation was found between CTA obstruction score and perfusion defect score (r=0.34, p=0.02). Mean pulmonary arterial pressure (mPAP) correlated with MPA diameter (r=0.4, p=0.02), RV wall thickness (r=0.6, p=0.0003) and the ratio of MPA diameter to ascending aortic diameter (r=0.5, p=0.002). Significant correlation was also found between RV wall thickness and pulmonary vascular resistance (PVR) (r=0.4, p=0.04). Neither CTA obstruction score nor perfusion defect score correlated with PVR and mPAP. The data of CT did not correlate with results of 6-minute walk test. Conclusion. In patients with CTEPH subtraction CTPA allows carrying out complex diagnostics of the state of vascular bed, parenchyma and perfusion of the lungs.

© 2018 Izdatel'stvo Meditsina.All rights reserved. Studied the diagnostic and prognostic significance of N-terminal precursor of natriuretic peptide C-type (NT-proCNP) and brain natriuretic peptide (NT-proBNP) in patients with COPD with pulmonary hypertension (PH). The study included 47 patients with COPD (II-IV degrees of severity, 2016 GOLD, men-44, women-3, mean age 59, 3±9.12 years, disease dura-tion of 13.7±5.93 years, the index of Smoking at 23.1±10, 93 pack-years, BAH of 27.2±12, 06 m!kg2.). Criteria of pulmonary hypertension on the basis of the doppler-echocardiography was an increase ofpulmonary artery systolic pressure (PASP) > 40 mmHg alone. Depending on the presence and degree of enhancement PASP patients were divided into three groups: I-without pulmonary hypertension (PASP < 40 mmHg, n=168), 2-moderate pulmonary hypertension (PASP 40-55 mmHg, n=101), 3-group with severe pulmonary hypertension (PASP > 55 mmHg, n=19). There was a statistically significant intergroup differ-ences (p. 2 0, 001, p J} 0, 001, pl3< 0, 001) values of NT-proCNP and NT-proBNP. There was a significant correlation relation-ship SDLA with the concentration of NT-proCNP (r=0, 53, p<0, 05) and NT-proBNP (r=0, 67; p=0, 05). A high diagnostic value of determination of NT-proCNP and NT-proBNP to predict the development and severity of PH in patients with COPD. Cox regression analysis showed that elevated levels of NT-proCNP and NT-proBNP in COPD patients ofPH c are the predictors of hospital mortality.Grant: The study had no sponsor support.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Purpose: to elucidate predictors of development of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary artery thromboembolism (PTE). Material and methods. We included in this study 210 patients hospitalized with diagnosis of submassive and massive PTE from 2013 to 2017. In 1 to 3 years after initial hospitalization these patients were invited for control examination. According to results of this examination patients were divided into two groups: with (group 1, n=45) and without (group 2, n=165) signs of CTEPH. Severity of pulmonary artery vascular bed involvement was assessed by multislice computed tomography (MSCT) angiography and lung scintigraphy. For detection of thrombosis in the inferior vena cava system we used ultrasound angioscanning. Examination also included echocardiography. Results. In the process of mathematical analysis, the following risk factors for the development of CTEPH embolism were determined: duration of thrombotic history (group 1 - 13.70±2.05 days, group 2- 16.16±1.13 days, p=0.015), localization of venous thrombosis in the lower extremities (the most favorable - shin veins, popliteal, and common femoral veins, unfavorable - superficial femoral vein). The choice of the drug for thrombolytic and anticoagulant therapy: streptokinase and urokinase were significantly more effective than alteplase, rivaroxaban was superior to the combination of unfractionated or low molecular weight heparins with warfarin. Also, risk factors for the development of CTEPH were the initial degree of pulmonary hypertension and tricuspid insufficiency, as well as the positive dynamics of these indicators at the background of thrombolytic or anticoagulant therapy. Of concomitant diseases, significant risk factors for development of CTEPH were grade 3 hypertensive disease, diabetes mellitus, postinfarction cardiosclerosis. On the other hand, age, gender, degree of severity at the time of admission, presence of infarction pneumonia, surgical prevention of recurrent pulmonary embolism, number of pregnancies and deliveries, history of trauma and malignancies, cardiac arrhythmias produced no significant impact on the development of CTEPH.

© 2018 Media Sphera Publishing Group. All rights reserved. At present, compelling evidence has been obtained that combined therapy of pulmonary arterial hypertension (PAH) with specific drugs can significantly slow progression of PAH. Therefore, in current guidelines combination therapy is already considered as standard treatment for a significant proportion of patients with moderately severe and severe forms of PAH. However, the quality of life and long-term prognosis of patients receiving combination therapy, should be the object of further research. The future research is absolutely necessary to identify the most optimal strategy of treatment of patients with PAH, such as initial combination therapy or rapid sequential combination therapy, double or triple combinations as well as exploring new signaling pathways PAH, which can become targets for new specific drugs PAH.

© Russian Journal of Cardiology.  Aim. Evaluation of clinical specifics, predictors of repeat hospitalizations and mortality in chronic obstructive pulmonary disease (COPD) patients according to pulmonary hypertension (PH) severity grade. Material and methods. To the study, 288 COPD patients included (II-IV severity grade, GOLD 2016; males 276, females 12; mean age 59,5±9,27 y. o., smoking 23,1±11,42 pack/years; 2,4±0,89 exacerbations annually, body mass index (BMI) 27,2±12,06 kg/m 2 ). According to the presence and grade of systolic pressure increase in pulmonary artery (SPPA) the patients were selected to three groups: 1st — with no PH (SPPA <40 mmHg, n=168), 2nd — with moderate PH (SPPA 40-55 mmHg, n=101), 3rd — with severe PH (SPPA >55 mmHg, n=19). Results. Increase of SPPA was found in 120 (41,7%) patients: moderate PA — in 101 (35,1%), severe PH — 19 (6,6%). It was shown that the presence and severity of PH do increase the severity of clinical signs of COPD, hemodynamic disorders, increase the rate of repeat hospitalizations and mortality rate. The predictors of repeat hospitalizations in COPD patients are increased SPPA and C-reactive protein concentration (CRP); mortality predictors are severity of symptoms by CAT, Borg dyspnea, number of exacerbations during one year, size of the right atrium, grade of SPPA increase, CRP concentration, fibrinogen, N-terminal precursors of C-natriuretic peptide (NT-proCNP) and brain peptide (NT-proBNP) in the blood. Conclusion. PH in COPD patients in most cases is moderate, and it worsens the clinical picture, hemodynamic disorders, shows only moderate correlation with breathing disorders, increases the rate of rehospitalizations and mortality risk. The survival rate of COPD and PH patients depends on the severity.