The dissertation is dedicated to finding ways to solve the vital task of internal medicine - improving the early diagnosis of pulmonary hypertension syndrome based on the analysis of clinical and medical history, structurally functional and biochemical markers of systemic inflammation and heart failure in patients with chronic obstructive pulmonary disease and concomitant coronary heart disease. 148 male patients aged 45 to 59 years, represented by three observation groups, were examined. The main group consisted of 100 patients diagnosed with a chronic obstructive pulmonary disease of groups A and B and the second severity of airflow rate restriction in combination with coronary heart disease, post-infarction cardiosclerosis and heart failure indications (CHF) of the II functional class. Patients of the main group were divided into three groups according to the presence of smoking factor, and depending on the level of mean pulmonary arterial pressure, the first group included 28 non-smoking patients with a normal mPAP level (less than 25 mm Hg), the second - 45 smokers with normal mPAP and the third - 27 smokers with elevated mPAP. Comparison groups were formed from 23 patients with COPD (fourth group) and 25 patients with coronary heart disease (fifth group), which in severity with COPD and CHD could be compared with patients in the main group. As a part of the study, it was found that patients with co-morbid pathology, in comparison with patients with isolated COPD and isolated CHD, have more apparent clinical symptoms of COPD and significantly lower exercise tolerance according to the results of assessing the severity of COPD using mMRC, CAT and a 6-minute walk test, worse indicators of external respiration function and more evident remodeling of the right ventricle of heart. A significant increase in the level of C-reactive protein and NTproBNP was also found in patients with a combination of COPD and CHD. The likely association of smoking with worsening exercise tolerance, increased serum concentrations of C-reactive protein, fibrinogen, and NT-proBNP has been identified in patients with COPD with concomitant CHD. Among the structural and functional indicators, a probable association of the smoking index with indicators of lung volume, forced expiratory volume in 1 second, average flow rate in the range from 25% to 75% of the forced vital capacity, mean pulmonary arterial pressure, endothelium-dependent vascular relaxation of brachial arteries, and the intima-media thickness was revealed, which confirms the negative impact of smoking on the pathogenesis of both diseases. It was determined that pulmonary heart syndrome is formed in 27% of patients with a combination of COPD and CHD, while the mean pulmonary arterial pressure ranges from 36.0 ± 5.6 mm Hg. A probable connection was established between the pulmonary pressure indicator and the duration of COPD, the smoking index, the severity of labored breathing according to the mMRC scale, the severity of COPD symptoms, the right auricle size, the increase in the level of C-reactive protein, NT-proBNP, the presence of endothelial dysfunction according to the results of the test with endothelium-dependent vascular relaxation of the brachial arteries, and a negative correlation with the respiratory function parameters. An original method is proposed for determining the mean pulmonary arterial pressure using a formula with the indicators such as the smoking index, forced expiratory volume in 1 second, average flow rate in the range from 25% to 75% of the forced vital capacity and the level of C-reactive protein in the blood serum, which will help optimize the early diagnosis of pulmonary hypertension syndrome and assess the prognosis in this category of patients.
