CARDIORENAL INTERRELATIONSHIPS IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE

The aim is to study the interrelationships between the state of pulmonary, intracardiac hemodynamics and renal blood flow in patients with chronic obstructive pulmonary disease (COPD) complicated with the chronic cor pulmonale (CCP). 75 patients with COPD complicated with compensated CCP who had the study of pulmonary, intracardiac and renal hemodynamics with the method of ultrasound duplex scanning were examined. The patients were divided into 2 groups: the 1^st group included 45 patients with COPD with pulmonary hypertension (PH) without clinical signs of right ventricle insufficiency; the 2^nd group included 30 patients with COPD and PH complicated with right ventricle insufficiency. It was found out that the patients with COPD alongside with the progression of the disease and development of the heart insufficiency had an increase of renal vessel resistance (р<0.01) and a decrease of the velocity of renal blood flow (р<0.001). In the first group of patients there was found a consistent correlation between the increase of the vessel resistance in renal arteries and growth of general peripheral vessel resistance (р<0.001), of systolic pressure in the pulmonary artery (р<0.001) and diastolic dysfunction of the left ventricle (LV) (р<0.001), suggested the influence of these predictors on the velocity of the arterial blood flow in kidneys. In the 2^nd group there was registered a strong correlation between the decrease of ejection fraction (EF) of LV and the increase of pulsation and resistive indices of arcuate arteries (r=0.69; p<0.01 and r=0.71; p<0.01, respectively), as well as the increase of end-diastolic volume, end-systolic volume of LV and speed parameters of the renal blood flow at all levels (r=0.67; p<0.01). The study of the relationship between the parameters of hemodynamics of the right ventricle (RV) and the state of the renal blood flow revealed a consistent correlation between the decrease of EF of RV and the decrease of diastolic rate at all levels of renal arteries (p<0.001), the increase of resistive (p<0.01) and pulsation indices (p<0.01) of the arterial system of kidneys. These correlations reflect a negative influence of both a left ventricle and right ventricle insufficiency on the state of the renal blood flow.

chronic obstructive pulmonary disease, chronic pulmonary heart disease, Doppler ultrasound, renal hemodynamics, pulsation index, resistive index, systolic diastolic ratio, maximum systolic velocity, end diastolic velocity

1. Авдеев С.Н., Алдашев А.А., Горбачевский С.В. и др. Легочная гипертензия. М.: ГЭОТАР-Медиа, 2015. 414 с.

2. Борзунова Н.С., Жданова Т.В., Борзунов И.В., Тутунина М.М. Анализ показателей периферической ренальной гемодинамики у пациентов с хроническими заболеваниями почек // Вестник уральской медицинской академической науки. 2014. Т.47, №1. С.36-37.

3. Вохминцева И.В., Меньшикова И.Г., Максименко Т.А. Допплерографическая оценка нарушений почечной гемодинамики у больных хроническим легочным сердцем // Ультразвуковая и функциональная диагностика. 2002. №2. С.222.

4. Ефремова Е.В., Шутов А.М. Клинические особенности, качество жизни и прогноз больных с хроническим кардиоренальным синдромом // Нефрология. 2015. Т.19, №2. С.63-67.

5. Кобалава Ж.Д., Виллевальде С.В., Ефремовцева М.А. Кардиоренальные взаимодействия при декомпенсации хронической сердечной недостаточности // Рациональная фармакотерапия в кардиологии. 2016. №2. С.138-146.

6. Меньшикова И.Г., Квасникова Ю.В., Вохминцева И.В., Скляр И.В. Ультразвуковая диагностика ранних признаков нарушений почечной гемодинамики у больных с хроническим легочным сердцем // Дальневосточный медицинский журнал. 2014. №4. С.12-15.

7. Levine R.A., Gibson T.C., Aretz T., Gillam L.D., Guyer D.E., King M.E., Weyman A.E. Echocardiographic measurement of right ventricular volume // Circulation. 1984. Vol.69, №3. Р.497-501.