The dissertation contains a new solution to an actual scientific and practical
task in the field of knowledge 22 "Health care" (specialty 222 "Medicine") -
improvement of course and dynamic forecasting observation in patients with
idiopathic pulmonary arterial hypertension (IPAH).
To implement the set goals and objectives, an open prospective comparative
single-center study was conducted, in which the data obtained during the clinical,
instrumental and laboratory examination of 108 people were analyzed: 78 patients
with IPAH, 30 practically healthy people (control group).
The main part of the study included 78 patients with ILAH who were
observed at the Center for Pulmonary Hypertension of the State University of the
National Center for Cardiology, Clinical and Regenerative Medicine named after
Acad. M.D. Strazheska" of the National Academy of Sciences of Ukraine at the
time of the study from 2020 to 2024 year. Of all patients, 65 (83.3%) were women,
and 13 (16.7%) were men. The median age of patients with ILAH was 48.00 (IQR
40.00 – 56.25) years. All patients with ILAH included in the study had a negative
vasoreactive test according to right heart catheterization data.
The group of patients with IPAH during the observation period was divided
into 2 separate groups: group 1 – patients who survived the observation period (60
people); group 2 - patients who died during the observation period (18 people).
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The control group of practically healthy people consisted of 30 people, of
whom 25 (83.3%) were women, and 5 (16.7%) were men. The median age of the
control group was 44.00 (IQR 32.75 – 63.50), p = 0.44.
According to the results of the instrumental study, it was established that in
patients with IPAH compared to the control group, systolic (p = 0.0001), diastolic
(p = 0.0001) blood pressure was lower; the heart rate was higher (p = 0.02); lower
SpO2 level (p = 0.038); a significantly shorter distance traveled according to the
data of the 6-minutes walk test (p = 0.0001).
According to the laboratory parameters in the group of IPAH patients, it was
higher compared to the control group: hemoglobin level (p = 0.012); creatinine
level 90 (p = 0.0001); uric acid level (p = 0.0001); NT-proBNP level (p = 0.0001).
As well as a lower blood potassium level (p = 0.001).
According to the data of transthoracic and speckle-tracking
echocardiography, in patients from the IPAH group, compared to the control
group, the following parameters were lower: LV area by 7.7%, LV area index by
23.1%, LV EF by 30.0%, LV SV by 27.5%, TAPSE by 26.9%, RV S` by 30.4%,
RV FAC by 52.0%, Right ventricular free wall longitudinal strain by 40.1%, Right
ventricular free wall longitudinal strain rate by 42.7%, Left ventricular global
longitudinal strain by 21.3%, Left ventricular global longitudinal strain rate by
25.4%; and the following indicators were higher: RA area by 76.0%, the basal size
of the RV by 33.2%, the ratio of the basal diameters of the RV/LV by 75%,
calculated RA pressure by 322%, the calculated PASP by 252.5%, PA diameter by
75%, eccentricity index in diastole by 50%, eccentricity index in systole by 90%.
Depending on the clinical course of patients with IPAH (group 1 and group
2), we made a similar comparison. In group 1, compared to group 2, patients with
IPAH had lower indicators: heart rate by 6.45%, sodium level by 2.2%, potassium
level by 7.3%; higher: SpO2 level by 4.9%, distance covered according to the data
of the 6-XX test by 21.7%, NT-proBNP level by 57.8%.
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According to transthoracic and speckle-tracking echocardiography, the
following parameters were higher in group 1 compared to group 2 of patients with
IPAH: LA area by 11%, LA area index by 24.2%, LV EDV by 11.3%, LV EF by
10,0%, PAT by 19.2%, TAPSE by 7.6%, RV S` by 103.8%, RV FAC by 17.8%,
Right ventricular free wall longitudinal strain by 15.13%, Left ventricular global
longitudinal strain by 15.9 %, Right ventricular free wall longitudinal strain/PASP
ratio by 63.6%; and the following indicators were lower: the ratio of the basal
diameters of the RV/LV by 15.6%, RV pressure by 17.5%.
Left ventricular diastolic dysfunction in patients with IPAH was found in 32
people (41.0%). According to the clinical course of the disease, it was established
that the prevalence of diastolic dysfunction of the left ventricle in group 1 in
patients with IPAH was 35% (in 21 people), which is significantly lower than in
group 2 in patients with IPAH - 61% (in 11 people), p = 0.01.
According to the analysis of the gas composition of blood in group 1
compared to group 2 of patients with IPAH, the partial pressure of arterial blood
O2 was higher by 25.9%, the partial pressure of arterial blood CO2 was higher by
11.1%, the SpO2 level of arterial blood was higher by 4.3%, Arterio-venous
difference for oxygen was lower by 11.6%, P50 of arterial blood was higher by
14.2%.
