Estimation of systolic and diastolic function of the left ventricular myocardium among patients with chronic cor pulmonale of broncho-pulmonary genesis in combination with hypertensive disease

Abstract

Chronic obstructive lung disease is the main reason for the development of chronic cor pulmonale. Comorbidity of this disease with cardiovascular pathology is the most important, reflecting the unity of cardiorespiratory system, becoming a summary integral factor of a negative prognosis: chronic obstructive lung disease and cardiovascular diseases are considered as “criminal partners”.The aim of the study was to investigate the functional state of left ventricular myocardium in patients with chronic cor pulmonale of bronchopulmonary genesis combined with hypertensive disease.Objects of the study were 96 patients with chronic cor pulmonale in combination with hypertensive disease depending on the disease severity. Among them 32 patients were without signs of circulatory insufficiency – compensation stage, and 64 were with signs of circulatory insufficiency of 2nd stage - decompensation stage – forming the main group. The comparative group included 64 patients with chronic cor pulmonale without hypertensive disease, among whom 32 patients without signs of circulatory insufficiency and 32 patients with signs of circulatory insufficiency of 2nd stage. The control group was consisted of 15 practically healthy individuals. All groups were of the same sex and age. It was established the systolic dysfunction of the left ventricle worsens in case of adding of hypertensive disease to chronic cor pulmonale. Revealed significant decrease of the stroke and cardiac indices, acceleration of blood flow through aortic valve, that resulted in decrease of ejection fraction, testifies about it. These differences were the most evident in patients of decompensation stage, when also increased hypertrophy of the left ventricular posterior wall and, particularly, interventricular septum was revealed. Diastolic dysfunction appears already on the background of chronic cor pulmonale formation in patients with chronic obstructive pulmonary disease and intensifies significantly in case of adding of hypertensive disease, in development of circulatory insufficiency particularly. It was confirmed by revealed changes of the left ventricular diastolic function of relaxation type among all the patients. They were reflected in diminishing of early diastolic filling velocity, ratio of early to late filling velocity, increase of isovolumic relaxation time, particularly in presence of hypertensive disease and signs of circulatory insufficiency. Significant thickening of interventricular septum also testifies about forming of left ventricular diastolic dysfunction.