Lilevska A. Optimization of diagnosis and prediction of the risk of coronary heart disease in patients with chronic ob-structive pulmonary disease

The thesis is devoted to the study of optimization methods for the diagnosis and prediction of risk of coronary heart disease in patients with chronic obstructive pulmonary disease. It is proved that comorbidity chronic obstructive pulmonary disease and coronary heart disease is accompanied by more pronounced than in the group with isolated chronic obstructive pulmonary disease, deterioration of quality of life score according to St. George’s Respiratory Questionnaire, high detection rate of atypical course of angina, atypical of its localization and irradiation, the increase in the frequency of silent myocardial ischemia, a higher frequency of diastolic dysfunction of the left ventricle, a greater pressure increase in the pulmonary artery and most expressed remodelation of the left heart. It is established that there are 6 criteria of the possibility of coronary heart disease in chronic obstructive pulmonary disease patients with a high information content and defined the following associations: the level of lipoprotein (a) more than 17 mg/dL and Pregnancy-associated Plasma Protein-A over 5мIU/l (sensitivity -88 %, specificity – 82 %, predictive value of positive result – 79 %, estimated value of a negative result – 96 %); the level of lipoprotein (a)more than 17 mg/dL and highly sensitive C-reactive protein greater than 4,5 mg/l (sensitivity – 85 %, specificity – 78 %, predictable value of positive result – 76 %, the perceived value of a negative result – 93 %); the level of lipoprotein (a) more than 17 mg/dL and the presence of the variant allele (T) of the gene Lys198Asn polymorphism in endotelin-1 (sensitivity – 83 %, specificity – 80 %, predictive value of positive result – 77 %, the expected value of a negative result – 95 %) and the level of Pregnancy-associated Plasma Protein-A is more 5мIU/l and highly sensitive C-reactive protein greater than 4,5 mg/l (sensitivity – 81 %, specificity – 78 %, predictive value of a positive result – 75 %, the perceived value of a negative result – 93 %).