[Features of central hemodynamics in patients with community - acquired pneumonia depending on the course of the disease and cardiovascular comorbidity].

AIM: The study of intracardiac hemodynamics and blood flow in the pulmonary circuit in patients with community - acquired pneumonia, depending on the presence of concomitant pathology of the cardiovascular system and the severity of the pathological process. MATERIALS AND METHODS: In 43 patients with community - acquired pneumonia (22 men, 21 women, mean age 67±17 years), the functional state of pulmonary - cardiac hemodynamics was assessed by echodoplerography. All subjects were divided into 2 groups: 1st group - 25 patients with community - acquired pneumonia (mean age 49±18 years) without concomitant pathology of the cardiovascular system and 2nd group - 18 patients with community - acquired pneumonia (mean age 70.1±11 years) with concomitant cardiovascular disease. RESULTS: The main ultrasound parameters did not differ from the normal values in patients from the 1st group. In patients from the 2nd group there was a significant deterioration of several pulmonary - cardiac hemodynamics parameters, decrease of left ventricular ejection fraction, significant myocardial hypertrophy of the left ventricle and left atrium size increase. Regarding the right heart chambers it was revealed dilatation of the right ventricle, increasing of the estimated systolic pressure in the right ventricle, deterioration of right ventricle myocardial diastolic function, increase of the: RV/LV size ratio, LV eccentricity index, RV myocardium thickness, diameter of the pulmonary artery, velocity of pulmonary regurgitation and the area right atrium size. In addition, the amplitude of systolic displacement of the tricuspid valve ring and the intensity of inspiratory collapse of the inferior vena cava decreased. Correlation analysis of clinical and laboratory parameters, which are markers of endogenous intoxication, oxygen saturation of arterial blood (SpO2), separately for two groups of patients with community - acquired pneumonia, showed a reliable correlation with a number of informative and used in the practice echocardiography parameters of pulmonary cardiac hemodynamics, characterizing systolic (systolic movement amplitude of the tricuspid valve ring - TAPSE), as well as diastolic function (E/A of the right ventricle) of the heart. CONCLUSION: The relationship between the severity of pulmonary - cardiac hemodynamics disturbances in patients with community - acquired pneumonia, having comorbid pathology, contributing to the deterioration of pulmonary - cardiac hemodynamics and more severe course of the disease with markers of the inflammatory process and oxygen saturation of arterial blood decrease is revealed.

Efficacy of Arbidol in the prevention of virus-induced exacerbations of bronchial asthma and chronic obstructive pulmonary disease.

AIM: To assess the efficacy and safety of Arbidol in the influenza and ARVI preventing in patients with asthma and chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: This study was an open label and prospective during epidemic period of 2016-2017 years. 100 outpatients aged 18 to 80 years with verified asthma and/or COPD, were enrolled to therapy group, and received oral umifenovir 200 mg once daily for 14 days and then 200 mg twice a week for 3 weeks.The medical records data for the same epidemic period of 2016-2017 seasons of the same patients during witch they received no prophylaxis was taken as a control. The data analysis was made by applying parametric and nonparametric statistical methods. RESULTS: Seasonal and post-exposure prophylaxis using umifenovir was associated with 2.6-times reduction in influenza and ARVI morbidity compared to control. In diseased patients (ARVI) of the therapy group the number of patients with mild illness prevailed (62.2%) and was significantly differed from control (37.1%). Severity of catarrhal symptoms and intoxication, was reduced with umifenovir prophylaxis course and were mild in 67.6% and 67.6% respectively of therapy group compared with 43.3% and 46.4% of control. Influenza and ARVI complications were only detected in control group (4 cases). The percentage of patients with incidents of underlying disease exacerbation was 42% in therapy group and 93% in control group. Also, exacerbation in the therapy group were mild in 59.5% and 34.4% in control group, while moderate exacerbation prevailed in control group and was in 59.1% of cases with was significantly higher then in therapy group (39.3%). Results in more frequent use of adjuvant in the control group compared with the therapy group (81.7% and 59.5% respectively). Patients of control group had a higher risk of hospitalizations due to underlying disease aggravation (11.8%), compared with therapy group (9.5%) but these differences were not significant. CONCLUSION: Seasonal and post-exposure prophylaxis with Arbidol reduce influenza and ARVI morbidity in patients with asthma and COPD during epidemic period, frequency and severity of chronic obstructive pulmonary disease aggravations resulting in decrease in the number of hospitalizations. Also, prophylaxis with Arbidol reduced the severity of catarrhal symptoms and intoxication.

[Prospects for predicting the life expectancy of patients with chronic obstructive lung disease for refining indicators for lung transplantation]. / Vozmozhnosti prognozirovaniia prodolzhitel'nosti zhizni bol'nykh khronicheskoi obstruktivnoi bolezn'iu legkikh s tsel'iu utochnneniia pokazanii k transplantatsii legkikh.

Success of lung transplantation is largely determined by the patients' timely referral for surgery. However, the determinants of survival in patients with chronic obstructive pulmonary disease (COPD), potential lung recipients are to be established. To reveal the determinants of survival in patients with terminal respiratory failure, the data from a follow-up of 59 patients with COPD who met the generally accepted requirements for the recipients of an isolated lung were analyzed. The analysis of some clinical, functional, hemodynamic parameters established that the level of hypoxemia and the value of pulmonary systolic pressure were of the greatest prognostic value. The values of external respiratory function did not affect the patients' survival. Thus, patients with COPD should undergo lung transplantation if they have a pulmonary systolic pressure of over 50 mm Hg, pO2 of under 60 mm Hg, and no benefits from their conservative therapy.

[The diagnostic significance of clinical signs of right ventricular insufficiency in patients with chronic obstructive bronchitis]. / Diagnosticheskoe znachenie klinicheskikh priznakov nedostatochnosti pravogo zheludochka u bol'nykh khronicheskim obstruktivnym bronkhitom.

An echocardiographic study of right ventricular myocardial contractility in 123 patients with chronic obstructive bronchitis (COB) confirmed the suggestion that in COB patients symptoms of right ventricular failure (cyanosis, acrocyanosis, crural edema, dilated liver) may have extracardiac origin. In echocardiographic diagnosis of right ventricular failure one should measure the speed of the anterior wall movements in the systole, diastole and ejection fraction.

[Postpneumonectomy syndrome: several new anesthesiological and pathophysiological aspects]. / Postpnevmonéktomicheskii sindrom: nekotorye novye anesteziologicheskie i patofiziologicheskie aspekty problemy.

As a result of 10-year investigations a concept of postpneumonectomy syndrome (PPS) has been defined as a combination of acute respiratory disturbances due to alteration of filtration and absorption functions of the lungs along with systolic and diastolic right heart dysfunction. The aim of the study was to identify the details of PPS pathogenesis dependent on the initial right chamber pressure levels and a search for probable approaches to PPS correction. The study was carried out on 26 patients subject to pneumonectomy. Central hemodynamics along with filtration and absorption lung functions and changes in extravascular lung water (EVLW) have been studied. According to the data obtained, initial pulmonary hypertension definitely plays a certain part in PPS pathogenesis; upon the administration of a Ca-blocker finoptin, the right heart condition was characterized by a significant increase in EF and EDV, followed by an increase in blood flow and a drop an PCWP; all the patients have experienced an increase in EVLW up to 7-8 ml/kg. Though altered right heart diastolic function may play a key role in hemodynamic and gas exchange disturbances, the application of Ca-blockers is believed to be a possible approach to the correction of the above deviations.

[The contractile capacity of the myocardium in patients with chronic obstructive bronchitis]. / Sostoianie sokratitel'noi sposobnosti miokarda u bol'nykh khronicheskim obstruktivnym bronkhitom.

As many as 123 patients with chronic obstructive bronchitis (COB) were examined. Myocardial contractility was estimated by echocardiography. The data obtained indicate that in COB patients, the contractility of the right and left heart is disordered. The level of systolic pressure in the pulmonary artery did not exceed 45 mm Hg in COB patients and cannot be the cause of the overload of the right heart. The decrease of left ventricular contractility is not associated with the concomitant pathology of the cardiovascular system. The causes of myocardial contractility disorders in COB patients remain unclear.

[The hemodynamic status of patients with chronic obstructive bronchitis and different degrees of respiratory failure]. / Sostoianie gemodinamiki u bol'nykh khronicheskim obstruktivnym bronkhitom s razlichnoi stepen'iu dykhatel'noi nedostatochnosti.

Changes in myocardial function of the right ventricle depending on oxygen tension in arterial blood were studied in 95 patients suffering from chronic obstructive bronchitis (COB) characterized by dramatic bronchial patency impairment and varying degree of respiratory insufficiency. Central hemodynamics was examined by echo-Doppler-cardiography and integral rheography. It has been established that in COB patients, the status of hemodynamics agrees well with the grade of respiratory insufficiency. As hypoxia increases, systolic pressure in the pulmonary artery rises; the size of the right ventricle and the width of its anterior wall increase; contractile function of the right ventricle does not depend on changes in oxygen tension in arterial blood; the compensatory increase of the cardiac and stroke indices is accompanied, as hypoxia rises, by diminution of pulmonary vascular resistance.

[Current status of the problem of chronic cor pulmonale]. / Sostoianie problemy khronicheskogo legochnogo serdtsa.

Studies of great number of patients with chronic nonspecific pulmonary disease suggest that high levels of pulmonary hypertension are only observed in cases of pulmonary-arterial thromboembolism and primary pulmonary hypertension. In other pulmonary diseases, the significance of pulmonary hypertension seems to be overestimated, as blood pressure in the pulmonary circulation network has values, indicative of the absence of gross morphologic changes of the vascular bed of the lungs. The available indirect methods for the diagnosis of pulmonary hypertension in chronic nonspecific pulmonary disease patients with rather small blood pressure in the pulmonary circulation network are shown to be of little value. Large functional reserves of the right cardiac ventricle which make it possible to cope with a sudden pressure overstrain (to say nothing of the slowly augmenting one) are pointed out. It follows therefore that either as yet unknown factors contribute to the pathogenesis of chronic pulmonary heart decompensation, or there is virtually no decompensation, while the demonstrated clinical symptoms of systemic circulatory congestion are of extracardiac origin. Various aspects of the assessment of the role of pulmonary hypertension and clinical symptoms of decompensated pulmonary heart will be discussed in the next communication.

[Characteristics of the course of pulmonary hypertension in patients with chronic obstructive bronchitis (2)]. / Osobennosti techeniia legochnoi gipertenzii u bol'nykh khronicheskim obstruktivnym bronkhitom (soobshchenie 2-e).

The state of pulmonary circulation in patients with chronic bronchitis depends on the presence of obstruction, its progression, development of pulmonary hypertension, cor pulmonale and its decompensation. The authors recommend to administer nitrates of prolonged action to such patients.

[Diagnostic significance of various symptoms of right-ventricular insufficiency in patients with chronic obstructive bronchitis]. / O diagnosticheskoi znachimosti nekotorykh simptomov pravozheludochkovoi nedostatochnosti u bol'nykh khronicheskim obstruktivnym bronkhitom.

The paper is concerned with the results of echocardiography, Doppler cardiography, radionuclide investigation and direct pressure measurement in the peripheral vein in 22 patients with chronic obstructive bronchitis and 7 persons with normal bronchial permeability. It was shown that the diameter of the peripheral veins, the pressure and rate of the blood flow in them and liver enlargement in patients with chronic obstructive bronchitis depended, to a large extent, on respiratory fluctuations of intrathoracic pressure. A conclusion was made that peripheral vein swelling and liver enlargement which were considered to be common symptoms of the development of right ventricular insufficiency, resulted from an increase in intrathoracic pressure during exhalation making difficult blood venous return to the heart in patients with dramatic disorders of bronchial permeability.

[Effect of nitroglycerin on various indicators of hemodynamics in patients with chronic obstructive bronchitis complicated by pulmonary hypertension]. / Vliianie nitroglitserina na nekotorye pokazateli gemodinamiki u bol'nykh khronicheskim obstruktivnym bronkhitom, oslozhnennym legochnoi gipertenziei.

Kinetocardiography and integral rheography of the body were used to examine the effect of nitroglycerin on the hemodynamics in 17 patients with chronic obstructive bronchitis complicated by pulmonary hypertension. The drug exerted a pronounced hypotensive action on the pressure in the pulmonary artery, increased the cardiac output at the expense of the stroke volume, reduced the resistance to the pulmonary blood flow and the peripheral vascular resistance.