THE EYE — MIRROR OF CARDIOVASCULAR DISORDERS. EVOLUTION OF PERCEPTION ABOUT HYPERTENSIVE RETINOPATHY

Published data often contain conflicting views on the relationship of retina changes in arterial hypertension (HT) with cardiovascular disorders and target organs lesions. Along with the classification and pathophysiology of hypertensive retinopathy, evidence for its association with the HT course, target organ lesions and prognosis is presented. Functional disorders of the eyes point at the involvement of retina into the pathological process even in HT early stages and are able to reflect the severity of hypertension. This supports a close relationship of HT with eye disease as a target organ. Available data support also possibility to assess changes on the eye fundus in patients with uncomplicated HT, indicating that it was premature decision to exclude eyes from the list of target organs in HT

Cardiopulmonary factors associated with atrial fibrillation in patients with chronic obstructive pulmonary disease

Aim. To study the relationships between clinical and functional features of chronic obstructive pulmonary disease (COPD) and status of cardiovascular system with focus on identifying factors associated with the atrial fibrillation (AF) in patients with COPD.Material and methods. Patients (n=94) with COPD out of exacerbation and airways obstruction of 2-4 degree (GOLD 2013) were examined. The spirometry, daily pulse oximetry, 24-hour ECG and blood pressure monitoring with vascular wall stiffness estimation, echocardiography were performed. Levels of high-sensitivity C-reactive protein (CRP) werealso assessed.Results. AF paroxysms were found in 46 patients, including newly diagnosed ones in 22 patients. According to the results of multiple correlation analysis, the frequency of AF paroxysms correlated with forced expiratory volume in 1 sec (FEV1) (R=-0.348; p=0.013), minimum oxygen saturation of the blood (min%SpO2) (R=-0.356; p=0.011), CRP level (R=0.442; p=0.001), the sizes of both atria (p<0.001), isovolumic relaxation time (IVRT) of left ventricle (LV) (R=0.350; p=0.022), the right ventricle (RV) size (R=0.478; p<0.001), systolic blood pressure level in the pulmonary artery (PASP) (р<0.001), vascular stiffness - pulse wave velocity in aorta (PWao) (p=0.001). The influence of FEV1 on the left atrium volume index (χ2=7.0; p=0.008) and IVRT LV (χ2=7.9; p=0.005) was revealed. Correlations between min%SpO2 and IVRT and PWao were observed.Conclusion. Severe bronchial obstruction, hypoxemia, systemic inflammation with increase in vascular stiffness (PWao) and myocardium remodeling (increase in the sizes of both atria, PASP, RV size and diastolic dysfunction of LV) are the factors that associated with the occurrence of AF in patients with COPD

Клинико-функциональный статус пациентов с хронической обструктивной болезнью легких и фибрилляцией предсердий

The aim of this study was to investigate functional status and typical symptoms in patients with chronic obstructive pulmonary disease (COPD) and atrial fibrillation (AF). Methods. Stable patients with moderate to very severe COPD (n = 94) with or without AF were involved in the study. Spirometry, 24-h monitoring of electrocardiogram and arterial pressure were done in all patients. COPD symptoms were assessed using Modified Medical Research Council Scale (mMRC) and COPD Assessment Test (CAT). We analyzed a rate of moderate and severe acute exacerbations of COPD during the previous year; parameters of 6-minute walk test (distance, pulse oximetry and dyspnea using Borg’s scale) and BODE index. Results. AF paroxysms were registered in 46 patients; AF was asymptomatic in 22 patients. Thereafter, COPD patients were divided into two clusters, with and without AF. Comparison of the two clusters showed that patients with COPD and AF had more severe bronchial obstruction (p < 0.001), more frequent acute exacerbations of COPD (р = 0.038), more severe COPD symptoms (CAT, р < 0.001; mMRC, р = 0.007) and higher BODE index (р < 0.001). Also, patients with COPD and AF had more severe hypoxemia (р = 0.012), more severe dyspnea evaluated with Borg’s scale (р < 0.001) and shorter distance in 6-minute walk test (р ˂ 0.001) compared to COPD patient without AF. Conclusion. Higher rate of acute exacerbations of COPD, prominent decrease both in FEV1 and in physical tolerance, higher BODE index and higher mMRC and CAT scores were typical for COPD patients with AF paroxysms.В связи с высокой распространенностью и частой встречаемостью сочетания хронической обструктивной болезни легких (ХОБЛ) и фибрилляции предсердий (ФП) представляется актуальной разработка характерных для таких больных критериев своевременной диагностики и лечения данной аритмии, влияющей на прогноз заболевания. Целью исследования явилось изучение функционального статуса и выраженности симптомов, характерных для больных ХОБЛ с ФП, а также разработка критериев развития данной аритмии. Материалы и методы. Обследованы больные ХОБЛ (n = 94) II–IV степени (GOLD, 2017) вне обострения ХОБЛ как с ФП, так и без таковой. У всех пациентов выполнялась спирометрия, проводилось суточное мониторирование по Холтеру показателей электрокардиографии и данных артериального давления, а также оценка симптомов ХОБЛ с использованием модифицированной шкалы одышки (Modified Medical Research Council – mMRC) и оценочного теста по ХОБЛ (COPD Assessment Test – САТ); учитывались количество перенесенных среднетяжелых и тяжелых обострений ХОБЛ за предшествующий год, показатели пройденной дистанции при проведении 6-минутного шагового теста (6-МШТ) с оценкой параметров пульсоксиметрии, индекса BODE, одышки по шкале Борга. Результаты. Пароксизмы ФП выявлены у 46 больных, в 22 случаях отмечено бессимптомное течение ФП. В результате кластерного анализа выделены 2 кластера – больные ХОБЛ с ФП и ХОБЛ без ФП. В результате сравнительного анализа кластеров для больных ХОБЛ с ФП были характерны более высокие степень бронхообструкции (объем форсированного выдоха за 1-ю секунду (ОФВ1); p < 0,001), количество обострений ХОБЛ (р = 0,038), выраженность симптомов ХОБЛ (CAT; р < 0,001; mMRC; р = 0,007) и индекса BODE (р < 0,001). Также у больных ХОБЛ с аритмией отмечались выраженная гипоксемия (р = 0,012), б#ольшая степень одышки по шкале Борга (р < 0,001) и уменьшение пройденной дистанции (р ˂ 0,001) при проведении 6-МШТ в сравнении с кластером без ФП. Заключение. Для развития пароксизмов ФП характерны высокая частота обострений ХОБЛ, выраженное снижение ОФВ1, толерантности к физической нагрузке, а также повышение индекса BODE и баллов по вопросникам mMRC и CAT

Ожирение и метаболические нарушения у больных хронической обструктивной болезнью легких: возможности фенотипирования

The aim of the study was to compare clinical and functional features and healthrelated quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD) regarding to comorbid obesity as a phenotypic sign. Methods. Patient classification was performed using Kmeans clustering analysis (MacQueen). It resulted in the classification of subjects into four clinical groups with marked differences in COPD symptoms.Results. Subjects with obesity had severe airflow limitation and dyspnoea, frequent exacerbations, severely impaired HRQoL, poor survival, decreased physical activity, insulin resistance and increased systemic inflammation.Conclusion. Thus, COPD with comorbid obesity could be considered as a distinct phenotype of COPD with severe symptoms.Целью исследования явилось изучение клиникофункциональных параметров и качества жизни (КЖ) больных хронической обструктивной болезнью легких (ХОБЛ) c сопутствующим ожирением и метаболическими нарушениями с оценкой возможности их фенотипирования. На основании кластерного анализа, проведенного по методу kсредних МакКуина, выделены 4 группы пациентов с отличительными особенностями течения ХОБЛ. Установлено, что наличие сопутствующего ожирения у больных ХОБЛ ассоциировано со значительным снижением легочной функции, переносимости физической нагрузки, показателей КЖ и выживаемости, частыми обострениями, развитием инсулинорезистентности и активацией системных воспалительных реакций. Предполагается, что клинический вариант ХОБЛ с сопутствующим ожирением целесообразно рассматривать в качестве отдельного фенотипа заболевания, характеризующегося тяжелым течением

ACE inhibitors in arterial hypertension management: zofenopril – class-specific effects and extra benefits

The review is devoted to ACE inhibitor therapy in arterial hypertension (AH) management. The mechanisms of ACE inhibitors’ effects on oxidative stress, endothelial dysfunction, insulin and glucose metabolism are discussed. The data on pharmacological characteristics of zofenopril and its use in AH are presented

BLOOD PRESSURE AND ARTERIAL STIFFNESS DYNAMICS DEPENDING ON THE DURATION OF CPAP NIGHT SESSIONS IN PATIENTS WITH SEVERE OBSTRUCTIVE SLEEP APNEA

Background: Numerous studies on the pathophysiological mechanisms of obstructive sleep apnea discover the relationship between obstructive sleep apnea and cardiovascular diseases, its contribution to the development of resistant hypertension and endothelial remodeling. Continuous Positive Airway Pressure (CPAP) is the only reasonable pathogenetic therapy in these patients. This treatment regimen implies the creation of a “pneumatic stent” with a given level of positive pressure on the inhalation and exhalation of the patient, allowing to stabilize the lumen of the upper respiratory tract and prevent the pharyngeal collapse. However, the effects and the required duration of CPAP of night sessions to achieve the target values of blood pressure and restore arterial stiffness in patients with severe obstructive sleep apnea with resistant hypertension remain poorly understood. Objective: to study the dynamics of blood pressure, arterial stiffness and endothelial dysfunction in patients with severe obstructive sleep apnea with resistant hypertension, depending on the duration of auto-adjusting CPAP (A-Flex therapy). Methods: the prospective single-center study enrolled 168 patients with obstructive sleep apnea with resistant hypertension (139 males, 46,6 ± 9,0 y. o.) with apnea-hypopnea index >30 events /hour. The night polygraphy study was performed to calculate AHI, oxygen desaturation index, mean nocturnal saturation (SpO2 ) according to the requirements of American Academy of Sleep Medicine. Endothelial function of blood vessels was assessed manually to peripheral arterial tone. The reactive hyperemia index and augmentation index was calculated. Blood pressure was monitored by office measurement, daily monitoring of blood pressure, and by individual patient diaries. Optimal level of CPAP-treatment was adjusted at home. Apnea-hypopnea index, the level of air leakage, average pressure and compliance to CPAP-therapy were established in accordance with international requirements. Results: In the group of patients, treated with night sessions of A-Flex > 6 h/night, significant dynamics was observed by the 6th month of treatment. That is, a decrease in RHI by -1.33 (95% CI from -2.25 to -0.41; P = 0.002), a decrease in AI by -12.4% (95% CI from -18.42 to -6.38; P = 0.001), a decrease in mean SBP (24 h) by -33.6 mm Hg (95% CI from -44.1 to -23.2; P = 0.002) and decrease in mean DBP (24 h) by -20.2 mm Hg (95% CI from -29.4 to -11.1; P = 0.001), with a decrease in rate of morning rise of SPB by -22.4 mm Hg/h (95% CI from -24.7 to -20.1; P = 0.002) and a decrease in rate of morning rise of DPB by -17.4 mm Hg/h (95% CI from -19.5 to -15.3; P = 0.003). The best target values were achieved by the 12th month of treatment: a decrease in RHI by -2.11 (95% CI from -2.57 to -1.65; P = 0.001), a decrease in AI by -28.5% (95% CI from -37.06 to -19.94; P = 0.002), a decrease in mean SBP (24 h) by -39.7 mm Hg (95% CI from -48.9 to -30.5; P = 0.001) and decrease in mean DBP (24 h) by -26.8 mm Hg (95% CI from -36.1 to -17.5; P = 0.001), with a decrease in rate of morning rise of SPB by -22.5 mm Hg/h (95% CI from -23.6 to -21.4; P = 0.001) and a decrease in rate of morning rise of DPB by -19.4 mm Hg/h (95% CI from -20.7 to -18.1; P = 0.002). Conclusions: in patients with severe obstructive sleep apnea and resistant hypertension only CPAP-therapy in the A-Flex mode > 6 h/night allows to achieve target blood pressure, restores endothelial function and arterial stiffness, therefore reducing the risks of cardiovascular complications

RENAISSANCE OF ARTERIAL HYPERTENSION MONOTHERAPY – THE POSITION OF THIAZIDE DIURETICS

The importance of the optimal choice of antihypertensive treatment strategy is currently widely recognised. The evidence obtained over the last five years justifies the revision of the traditional approach towards the tactics of mono- and combination antihypertensive therapy. It is essential to ensure that the patient-centred tactics of mono- and combination therapy choice is based on the detailed analysis of the clinical status

THE ASSOCIATION BETWEEN INTRACARDIAC HEMODYNAMICS AND LUNG FUNCTION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Study objective. To assess the association between intracardiac hemodynamics and airway obstruction with pulmonary hyperinflation in patients with chronic obstructive pulmonary disease.Materials and methods. Ninety-six patients with chronic obstructive pulmonary disease, aged 40 to 75 years, without concomitant cardiovascular disease, were examined and divided into 4 groups according to the severity of the disease. The patients underwent general clinical examination, spirometry, 24-hour pulse oximetry and echocardiography with assessment of linear and volumetric parameters, as well as diastolic function of left and right ventricles.Results. Linear and volumetric parameters of the left ventricle, LV myocardial mass and geometry in the examined patients with chronic obstructive pulmonary disease matched threshold values. The progression of the severity of chronic obstructive pulmonary disease was accompanied by decrease of the end-diastolic size of the left ventricle, ratio of peak early to late diastolic filling velocity for the left ventricle (E/A) without significant changes in the left ventricle isovolumetric relaxation time (IVRT). Moderate correlations of the inspiratory capacity with the end-diastolic size of the left ventricle (r=0.612; p=0.001) and the left ventricle E/A (r=0.464; p=0.001); forced expiratory volume in 1 second (FEV1) with the left ventricle E/A (r=0.600; p=0.011) were established. As a result of the logistic regression performed, the predictor value of the inspiratory capacity was confirmed (Wald χ2 — 5.795; р=0.024). Impairment of left ventricular diastolic function of grade I was revealed in 12 (31.6 %) patients in group 2, in 7 (24.1 %) patients in group 3, and in 9 (56.2 %) patients in group 4.Conclusion. Airway obstruction severity and pulmonary hyperinflation progression in patients with chronic obstructive pulmonary disease and without concomitant cardiovascular disease is associated with a decrease of left ventricular size and diastolic filling, contributes to the development of the left ventricular diastolic dysfunction, predominantly due to the decrease in filling velocity parameters

RECENT ASPECTS OF CARDIAC REMODELING IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

The paper aimed to present evidence of the effect of some pathophysiological features of chronic obstructive pulmonary disease (COPD) on cardiac remodeling in patients free of overt cardiovascular diseases, traditional cardiovascular risk factors and pulmonary hypertension. Contrary to traditional beliefs that cardiac abnormalities in COPD have been mainly associated with the right ventricle, several recent studies have shown an independent effect of pulmonary hyperinflation and emphysema on left ventricular (LV) diastolic filling and LV hypertrophy. Pulmonary hyperinflation and emphysema cause intrathoracic hypovolemia, low preload, small end-diastolic dimension and mechanical compression of LV chamber which could worsen end-diastolic stiffness. Interestingly, that the presence of LV hypertrophy in COPD patients is important but currently poorly understood area of investigation. Pulmonary hyperinflation, increased arterial stiffness and sympathetic activation may be associated with LV hypertrophy. Two-dimensional ultrasound speckle tracking studies have shown the presence of sub-clinical LV systolic dysfunction in patients even with moderate COPD and free of overt cardiovascular diseases. Sarcopenia related to the inflammatory-catabolic state in COPD and hypoxia could play an important role regarding LV systolic dysfunction. Recent data reported the effects of long-acting bronchodilators on reducing lung hyperinflation (inducing lung deflation). Further studies are required to evaluate the effects of pharmacological lung deflation therapy on cardiac volume and function