THEORETICAL ASPECTS IN THE FORMATION OF
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International scientific-online conference
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DIASTOLIC DYSFUNCTION OF THE RIGHT VENTRICLE IN
PATIENTS WITH CHRONIC PULMONARY HEART DISEASE IN THE
CONTEXT OF COMPREHENSIVE TREATMENT (EMPHASIS ON THE
VASOREGULATORY FUNCTION OF THE ENDOTHELIUM)
Normatova K.Sh.
Karimov M.Sh.
Tukhtaeva N.Kh.
Azimova M.М.
Tashkent Medical Academy, Tashkent, Uzbekistan.
https://doi.org/10.5281/zenodo.14969990
Relevance.
In recent years, Uzbekistan has observed an increase in the
prevalence and mortality of lung diseases complicated by pulmonary arterial
hypertension (PAH) and chronic pulmonary heart disease (CPHD). For the early
diagnosis, adequate prevention, and treatment of CPHD, it is essential to clarify
the factors that lead to its development and exacerbate its course
1
.
Objective of the Study.
To examine the condition of diastolic function of
the right ventricle (RV), pulmonary hemodynamics, and the vasoregulatory
function of the endothelium of peripheral vessels in patients with CPHD during
comprehensive treatment.
Materials and Methods.
A total of 53 patients with COPD (average age:
49.7 ± 2.8 years, disease duration: 10.7 ± 2.9 years) whose condition was
complicated by PAH with a mean pulmonary arterial pressure (mPAP)
exceeding 25 mmHg were examined. Additionally, 40 COPD patients (average
age: 56.9 ± 2.6 years, disease duration: 16.8 ± 3.7 years) with RV hypertrophy
and 20 healthy individuals were included.
The patients were randomized into three subgroups based on their
treatment methods:
Subgroup A
: 14 COPD patients with RV hypertrophy (1a) and 17 COPD
patients with PAH (2a) receiving basic therapy (BT).
Subgroup B
: 12 COPD patients with RV hypertrophy (1b) and 17 COPD
patients with PAH (2b) receiving BT with amlodipine (5–10 mg/day) and ozone
therapy (OT).
Subgroup C
: 14 COPD patients with RV hypertrophy (1c) and 19 COPD
patients with PAH (2c) receiving BT combined with OT.
Basic therapy included
:
β-agonists + anticholinergic inhalers, anti-leukotrienes, methylxanthines, β-
agonists, glucocorticosteroids, along with ImmunoHelp capsules (1 capsule,
THEORETICAL ASPECTS IN THE FORMATION OF
PEDAGOGICAL SCIENCES
International scientific-online conference
205
three times daily), chest massage, and breathing exercises. The effectiveness of
treatment regimens was evaluated dynamically on the 10th day of therapy.
Psycho-emotional status was assessed through psychological testing for
reactive anxiety (RA) and personal anxiety (PA).
Endothelium-dependent vasodilation (EDVD) was evaluated via Doppler
imaging of the brachial artery (BA), measuring the maximal systolic blood flow
velocity (MSV, m/s) and vascular resistance index (VRI, units) in response to a
compression test (CT).
Doppler echocardiography assessed diastolic function indicators, mean
pulmonary arterial pressure levels, and the stable metabolites of nitric oxide
(SMNO) in plasma.
Results.
The study revealed that COPD patients with CPHD exhibit an
imbalance in SMNO levels in plasma and reduced capacity for active EDVD in BA.
Analysis of reactive hyperemia tests demonstrated a significant reduction in
MSV among CPHD patients, correlating with disease severity. Compared to
healthy individuals, MSV in CPHD patients decreased by 32.9% and 19.2%,
respectively, while VRI increased by 38.6% and 28.0%. Along with impaired
EDVD, diastolic dysfunction of the RV was observed. Notably, RV dysfunction
positively correlated with SMNO levels (r=0.32, p<0.05).
Conclusions.
1.The most pronounced reduction in SMNO levels, EDVD, and affective
symptoms was observed in COPD patients with RV hypertrophy compared to
those with PAH. RV dysfunction positively correlated with SMNO levels (r=0.32,
p<0.05).
2.OT and amlodipine in combination with BT significantly normalized
SMNO levels, improving EDVD and RV diastolic function, reducing mPAP, and
alleviating affective symptoms in COPD patients with CPHD complications.
