[Cardiac comorbidity in patients with chronic obstructive pulmonary disease: diagnosis and economics].

AIM: To provide a clinical and economic rationale for the comprehensive examination of patients with chronic obstructive pulmonary disease (COPD), by using functional and ultrasound methods for the early detection of cardiac comorbidity. SUBJECTS AND METHODS: Three hundred and sixteen patients (33 with COPD, 44 with COPD + hypertension, 73 with COPD + coronary heart disease (CHD), 36 with hypertension, 50 with CHD, 19 with asthma, and 28 with asthma + hypertension) and 33 apparently healthy individuals were examined using 611 indicators obtained directly or by calculation during echocardiography, carotid artery duplex scanning, and 24-hour electrocardiographic (ECG) and blood pressure (BP) monitoring. RESULTS: Cardiovascular diseases develop in patients with COPD in its early stages. In cardiac comorbidity, the length of hospital stay increases by 1-1.5 days in patients with COPD; the number of people admitted to hospital more than once every 3 years rises from 14 to 28%; the cost of a pharmacotherapy cycle is 1.35- and 2.95-fold higher when COPD is concurrent with hypertension and CHD, respectively. CONCLUSION: In addition to ECG and spirometry, the management standard for patients with COPD should include echocardiography, 24-hour ECG and BP monitoring, and, according to their results, carotid artery duplex scanning.

[Clinical and diagnostic significance of intima-media thickness in chronic obstructive pulmonary disease].

AIM: To estimate changes in common carotid artery (CCA) intima-media thickness (TIM) in patients with the isolated form of chronic obstructive pulmonary disease (COPD) or that concurrent with coronary heart disease (CHD) and arterial hypertension (AH). SUBJECTS AND METHODS: Carotid duplex scanning, echocardiography, electrocardiogram (ECG) Holter monitoring, and spirometry were performed in 150 patients with COPD, COPD + AH, or COPD + CHD and in 33 apparently healthy men and women aged 39-77 years. RESULTS: An increase in TIM (more than 0.9 mm) was determined in 54.5% of the patients with isolated COPD, in 76.7% of those with COPD + CHD, and in 68.2% of those with COPD + AH. The correlation coefficient between TIM and age varied from 0.3 to 0.49 (controls 0.66) whereas that with the degree of bronchial obstruction (forced expiratory volume in one second) was statistically insignificant. In isolated COPD, the increase in CCA TIM was determined from the presence of right ventricular hypertrophy. Hemodynamic relevant supraventricular and ventricular premature beats were more frequently recorded in the presence of increased TIM and only in the COPD + AH group. Changed heart rate variability with the predominance of sympathetic tone over parasympathetic one was observed in all the patients with COPD and increased TIM. CONCLUSION: The widespread increase in CCA TIM in patients with COPD shows the need for carotid duplex scanning in this contingent of patients, primarily in persons over the age of 50 years with Stage III--IV COPD concurrent with CHD or AH.

[Dispersion of QT interval during holter monitoring in patients with chronic obstructive pulmonary disease and bronchial asthma].

The aim of the work was to estimate dispersion of QT interval during Holler monitoring in patients with chronic obstructive pulmonary disease (COPD) and arterial hypertension (AH). The study involved 28 patients with COPD (including 17 with COPD + AH), 31 patients with bronchial asthma (BA) (including16 with BA + AH), and 17 practically healthy subjects. It was shown that a combination of COPD and AH is associated with high-grade ventricular arrhythmia (by Lown-Wolf classification). Dispersion of QT interval indicates that the risk of life-threatening arrhythmia in patients with COPD and AH is unrelated to ventricular extrasystole and ventricular myocardium mass. Patients with BA and AH exhibited electrical instability regardless of myocardial mass only in the presence of ventricular arrhythmia. In the patients with BA and AH the QTcd interval increased in the second half of day, in COPD patients from morning till evening, and in patients with COPD + AH during 24 hours.