The dissertation is devoted to improving the diagnosis and increasing the effectiveness of treatment of patients with chronic heart failure (CHF) associated with stable ischаemic heart disease (SIHD) in combination with chronic obstructive pulmonary disease (COPD), by determining the phenotypes of heart remodeling, cardiopulmonary relationships, health related quality of life (HRQoL), optimization of anti-ischаemic and bronchodilator therapy.
To achieve the goal, the following research methods were used: physical examination, laboratory studies, including determination of the level of NT-proBNP, instrumental: electrocardiography (ECG), transthoracic Doppler echocardiography, lung ultrasound with detection of B-lines as signs of pulmonary congestion, carotid ultrasonography, ambulatory ECG monitoring (AECG), spirometry, pulsoximetry (SpO2), cardiopulmonary exercise test; patient questionnaires: validated quality of life questionnaires SF-36, SGRQ, adherence to treatment Morisky-Green MMAS-8; statistical methods.
At the first stage of the study, a retrospective analysis of 146 inpatient medical records of patients with SIHD combined with COPD was performed.
The scientific novelty of the results obtained. The research is aimed at the further development of the concept of the cardiopulmonary continuum in IHD combined with COPD at the stage of HF formation. For the first time in patients with IHD and COPD, a comprehensive approach was applied to study the formation of CHF on the basis of established phenotypes of cardiac remodeling, formation of pulmonary hypertension, features of cardiopulmonary relationships, assessment of autonomic imbalance and tolerance to physical exertion. In patients with IHD combined with COPD, the diagnostic value of the validated HFA-PEFF and H2FPEF scores was first compared in the identification of HFpEF in this cohort of patients, and greater accuracy was determined for the HFA-PEFF score. The connections between hemodynamic overload of the heart and hypoxaemia with silent myocardial ischaemia and the formation of HFpEF in patients with stable IHD combined with COPD has been established. In the dissertation, for the first time, on the basis of multivariate regression analysis, a personalized calculation of the proper distance of 6MWT in patients with CHF assotiated with IHD combined with COPD is proposed on the basis of dyspnea severity according to mMDR score, the functional class of CHF (NYHA) or angina, the duration of IHD for the assessment of exercise tolerance. The clinical and functional characteristics that negatively affect the quality of life and adherence to treatment of patients with CHF, associated with SIHD in combination with COPD have been clarified. The inclusion of nebivolol, valsartan, eplerenone, rosuvastatin and acetylsalicylic acid in the complex therapy of HFpEF associated with stable IHD combined with COPD, and double bronchodilation therapy with a fixed combination of umeclidinium bromide and vilanterol was justified. The additional use of L-arginine contributed to the greater effectiveness of the treatment of chronic heart failure due to the slowing down of pathological remodeling of the heart, improvement of cardiopulmonary relationships and tolerance to physical exertion of patients in this category.
