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PUBLISHED DATE: - 09-10-2024
https://doi.org/10.37547/TAJMSPR/Volume06Issue10-04
PAGE NO.: - 21-26
MAIN ECHOCARDIOGRAPHIC PARAMETERS
IN PATIENTS WITH CHRONIC CEREBRAL
ISCHEMIA DEPENDING ON THE PRESENCE
OF CONCOMITANT CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
L.M. Zakirova
Andijan State Medical Institute, Uzbekistan
J.A. Nazarova
Center for the Development of Professional Qualifications of Medical
Workers of the Ministry of Health of the Republic of Uzbekistan, Uzbekistan
INTRODUCTION
According to the World Health Organization,
chronic obstructive pulmonary disease (COPD)
caused the death of 2.32 million people in 2019 [1].
Chronic inflammation, progressive emphysema,
and pulmonary hyperinflation lead to an increase
in the afterload on the right ventricle (RV) in
patients with COPD due to an increase in
pulmonary vascular resistance and a moderate
increase in systolic pressure in the pulmonary
artery (PA), which over time causes structural
changes in the right chambers of the heart and
right ventricular failure [1,2].
The first key provision of chronic obstructive
pulmonary disease (COPD) is a disease
characterized by significant extrapulmonary
manifestations that can further aggravate the
course of the disease in individual patients [4,5].
According to the results of a large study in patients
RESEARCH ARTICLE
Open Access
Abstract
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hospitalized for exacerbation of COPD, the
prevalence of comorbidity with
arterial
hypertension (AH) is 65.6% [4,5].
Aim
: To study the main echocardiographic
parameters in patients with chronic cerebral
ischemia depending on the presence of
concomitant chronic obstructive pulmonary
disease.
METHODS
Over a period of 3 years, patients were selected: 1)
patients with CCI stage II with concomitant COPD
(main group - MG); 2) patients with CCI stage II
without COPD (comparison group - CG). The
control group (CG) included 20 patients, 10 men
and 10 women, average age 63.1±6.4 years (Table
1).
The MG comprised 57 patients (47.5%) and the CG
comprised 63 patients (52.5%). As can be seen
from Table 1, the MG had a predominance of males
- 34 (59.6%) versus females - 23 (40.4%) (p <
0.05). In the CG, there was a predominance of
women - 36 (57.1%), the proportion of men was
42.9% (p < 0.05). The groups were dominated by
elderly people according to WHO, 2022.
The diagnosis and stages of CIM were established
according to the generally accepted criteria for the
Republic after conducting thorough clinical,
neurological,
neuropsychological
and
instrumental (duplex scanning, MRI of the brain)
studies (3).
The diagnosis of COPD was made on the basis of
complaints (shortness of breath, cough with
sputum), clinical picture of the disease, anamnestic
data (presence of risk factors), results of physical
and
laboratory
examination
methods,
instrumental data (measurements of airflow
limitation (spirometry) - the ratio of FEV1 / FVC <
70%; post-bronchodilator value of FEV1 less than
80% of the expected) in accordance with the
“Global strategy for the diagnosis, treatment and
prevention of chronic obstructive pulmonary
disease” (National Heart, Lung, and Blood
Institute; revision 2008) and the “Respiratory
Med
icine Guidelines” (6).
Table.1.
Distribution of patients by groups, gender and age
Groups
gender
Age, WHO, 2022
60 - 74 years
old
75 - 90 years
old
total
M
abs
13
21
34
MG
%
38,2%
61,8%
59,6%
n=57
F
abs
9
14
23
%
39,1%
60,9%
40,4%
total
abs
22
35
57
%
38,6%
61,4%
47,5%
M
abs
9
18
27
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CG
%
33,3%
66,7%
42,9%
n=63
F
abs
12
24
36
%
33,3%
66,7%
57,1%
total
abs
21
42
63
%
33,3%
66,7%
52,5%
M
абс
22
39
61
Total
%
36,1%
63,9%
50,8%
n=120
F
abs
21
38
59
%
35,6%
64,4%
49,2%
total
abs
43
77
120
%
35,8%
64,2%
100,0%
Note: OG - main group; CG - comparison group; m - men; f - women; abs - absolute
values; WHO - World Health Organization.
All patients underwent a standard clinical and
neurological examination (analysis of patient
complaints, life history and medical history,
objective examination, including study of
neurological status) and somatic examination.
Electrocardiography was performed in 3 standard
and 6 chest leads with the assessment of the
following parameters: signs of right heart
hypertrophy, signs of left heart hypertrophy, signs
of combined lesions. All patients underwent
echocardiography (ECHOCG) (Vivid 9, GE
Healthcare, USA). The following parameters were
assessed using the apical four- and two-chamber
position: sizes of the right and left atria (RA and
LA), right and left ventricles (RV and LV), mean
PAP, end-diastolic volume (EDV) and end-systolic
volume (ESV) of the LV, ejection fraction (EF)
according to Simpson, LV diastolic dysfunction
parameters (LVD).
Statistical processing of the research results was
carried out using variation statistics methods
using Microsoft Office Excel-2019 programs.
RESULTS
In order to identify signs of overload and/or
hypertrophy of the right heart, all patients
underwent such studies as ECG and ECHO-CG. On
ECG, signs of hypertrophy of the left heart were
detected in 54 (94.7%) patients of the MG, 48
(76.2%) patients of the CG. Signs of hypertrophy of
the right heart: MG - 32 (56.1%) patients, CG - 5
(7.9%) patients, data for hypertrophy of the right
and left heart - in 7 (13.2%) patients of the MG, 0
(0.0%) patients of the CG. Reliable differences
were revealed among patients of the MG and CG
(p> 0.05).
The systolic pressure in the pulmonary artery
(SPPA), measured by echocardiography, averaged
42.4±33.7 mm Hg. Increased systolic pressure in
the pulmonary artery and hypertrophy of the right
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heart were significantly more common in the MG.
Figure 1. Percentage of identified patients with elevated pressure (more
than 30 mm Hg) in the pulmonary vein
A mean pulmonary artery pressure (MPAP) of
more than 20 mm Hg was considered
characteristic of pulmonary hypertension. An
increase in MPAP in the MG was detected in 38
people (66.7%). The MPAP level varied from 21.7
to 34. In the CG, MPAP was initially within the
normal range
–
17.3+1.4 mm Hg.
Echocardiography to assess primarily the right
heart and pulmonary artery pressure. The
echocardiography results in the groups are
presented in Table 2. As can be seen from Tables 2
and 3, statistically significant differences between
the parameters were recorded when assessing the
left ventricular end-systolic size, interventricular
septum thickness, LV myocardial mass index, atrial
areas, and some right ventricular dimensions
(p<0.05).
Table 2
Main echocardiographic parameters of the left heart chambers in patients
with chronic myocardial infarction depending on the presence of
concomitant COPD
Indicators
ОГ, п=57
ГС, п=63
р<
0
20
40
60
ОГ, п=57
ГС, п=63
49.2
31.5
Signs of increased pulmonary artery pressure over
30 mm Hg (%)
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LV EDS, cm
5,1±0,49
5,2±0,78
LV ESR, cm
3,2±0,41
3,4±0,67
0,05
T MZhP, cm
1,18±0,13
1,24±0,22
0,05
T ZS, cm
1,13±0,10
1,15±0,16
OTM, units
0,46±0,04
0,46±0,07
LV IMM, g/m2
109,0±17,2
117,9±20,2
0,05
LVEF according to Simpson,
%
60,2±4,5
55,7±14,9
S LP, cm2
15,5±3,1
19,5±5,05
0,05
As mentioned earlier, one of the objectives of the
study was to identify predictors of myocardial
damage in patients with a high risk of apnea
syndrome. For this purpose, the method of
stepwise regression analysis was used. According
to the regression equations, the degree of risk of
apnea syndrome participated as an independent
predictor both in the development of pathological
remodeling of the heart and in the processes of
diastolic dysfunction of the right ventricle.
The contribution of dynamic obstruction of the
upper respiratory tract during sleep to the process
of pathological remodeling was also indirect,
through the development of nocturnal systolic
hypertension and changes in the morning
dynamics of blood pressure.
Table 3
Main echocardiographic parameters of the right heart chambers in patients
with chronic myocardial infarction depending on the presence of
concomitant COPD
Indicators
MG ,
п=57
CG, n=63
р<
PJ-lax, cm
2,9±0,27
3,1±0,32
0,05
PJ-sax, cm
2,5±0,28
2,5±0,43
PJ-diam.base, cm
3,8±0,37
4,1±0,71
0,05
S PP, cm2
16,5±4,6
18,9±5,7
0,05
FI-S PJ,%
47,4±12,8
51,3±9,5
TAPSE, cm
2,3±0,54
2,1±0,5
LA, cm
2,1±0,19
2,1±0,18
Average pressure in the pulmonary artery, mm
Hg.
28,4±4,74
29,5±5,98
0,05
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CONCLUSION
In patients with OH, a slight relative dilatation of
the RV and RA, diastolic dysfunction of the LV, a
decrease in Sm of the fibrous ring of the mitral and
tricuspid valves is detected; diastolic dysfunction
of the RV, RV hypertrophy is formed. According to
the regression equations, the degree of risk of
apnea syndrome appeared as an independent
predictor in the development of pathological
remodeling of the heart, and in the processes of
diastolic dysfunction of the RV.
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