[Evaluation of diagnostic criteria of heart failure in patients with atrial fibrillation and chronic obstructive pulmonary disease].

AIM: Assess the diagnostic significance of markers of heart failure, to identify the features of clinical symptoms and structural and functional remodeling of the left and right heart in patients with chronic heart failure (CHF) in combination with atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: groups of patients were formed: group 1 - patients with COPD without cardiovascular diseases (n=28), group 2 - patients with CHF and COPD without AF (n=30), group 3 - patients with CHF and AF without COPD (n=33), group 4 (main) - patients with CHF, AF and COPD (n=29). Patients were evaluated for clinical symptoms, 6-minute walk test, echocardiographic study, determined the concentration of natriuretic peptides (NUP): N-terminal fragment of the precursor of cerebral NUP (NT-proBNP) and mid-regional pro-atrial NUP (MR-proANP). RESULTS: In patients with CHF on the background of AF and COPD, a higher score of the severity of clinical symptoms was established in comparison with the 3rd group (p<0,001). The features of heart remodeling in patients of the main group were revealed in comparison with patients with CHF and AF without COPD: lower volume indices of the left (p=0,001) and right (p=0,004) atria and values of the indexed index of the end-diastolic area of the right ventricle (RV) (p=0,007), lower contractility of the RV, the presence of RV hypertrophy. The effect of AF on the structural and functional parameters of the heart in patients with CHF, COPD and AF can be judged by comparison with patients with CHF and COPD without AF: higher values of the size of the RV (p=0,012), indexed index of the end-systolic area of the RV (p<0,001), lower systolic function of the RV on the background of higher pressure in the RV cavity (p=0,001). Defined the highest level of NT-proBNP in patients with CHF, AF and COPD in comparison with its level in patients of the 2nd group (p<0,001) and in patients 3rd groups (p=0,010). Higher levels of MR-proANP were found in patients with CHF and AF without COPD (p<0,001). CONCLUSION: In patients with CHF, AF and COPD, more pronounced clinical symptoms are caused by chronic bronchial obstruction. Pathogenetic features of left and right heart remodeling in patients with CHF on the background of AF and COPD were revealed. For the early detection of HF in patients with AF the greatest diagnostic importance is the determination of the level of MR-proANP, however, in patients with combined AF and COPD the most informative is the determination of the concentration of NT-proBNP.

[Evaluating the effectiveness of a fixed combination of amlodipine and bisoprolol in ambulatory patients with arterial hypertension and ischemic heart disease].

OBJECTIVE: To evaluate the efficacy and safety of a fixed-term combination of ß-blocker bisoprolol and the calcium antagonist amlodipine in the outpatient treatment of patients with arterial hypertension (AH) and coronary heart disease (CHD). The study involved 100 patients with hypertension 1-3 first degree and CHD, which previous antihypertensive therapy was ineffective or irregular. Inclusion in the treatment regimen of amlodipine was associated with significant decrease in blood pressure (BP) with the achievement of the target level of systolic blood pressure of 90%, diastolic blood pressure--in 97% of cases after 4 weeks treatment. Analysis of the dynamics of the heart rate during the visits to the doctor and the patient diary data revealed a significant slowing on the background of the therapy, which is important for patients with coronary artery disease. In carrying out daily monitoring of ECG Holter dynamics observed a decrease in the average duration of episodes of depression segment ST on 50.5% (p < 0.05) and the number of ischemic episodes at 54.8% (p < 0.05). The use of fixed-dose combination of bisoprolol and amlodipine allowed to increase the compliance of patients with treatment 2.2 times.