Analysis of clinical and diagnostic peculiarities and approaches to therapy in patients with different hemodynamic phenotypes of pulmonary hypertension
Abstract. Pulmonary hypertension (PH) occurs in various cardiovascular diseases and is characterized by increased pressure in the pulmonary artery. Often it develops in presence of left heart damage, which is associated with the progression of the underlying disease and heart failure. Idiopathic pulmonary arterial hypertension (IPAH) belongs to the group of rare (orphan) pathologies.Devetyarova E.A., Chesnikova A.I., Dyuzhikova A.V., Kolomatskaya O.E.
The aim: to identify the peculiarities of the clinical course, structural and functional remodeling of heart and hemodynamics of the pulmonary circulation, as well as approaches to treatment in patients with IPAH and PH associated with chronic heart failure (CHF) of ischemic genesis.
Material and methods. The study included patients over 18 years old with IPAH (n = 32) and PH associated with CHF of ischemic genesis (n = 31). The following research methods were used: electrocardiography (ECG), echocardiography (EchoCG), chest radiography, Holter ECG monitoring, laboratory tests. Verification of the diagnosis was performed using transvenous cardiac catheterization.
Results. It was found that patients with IPAH were younger, female individuals predominated, syncope, severe cyanosis, and jugular vein dilation were more often observed in the clinical picture, and echocardiography revealed more severe pulmonary hypertension, overload of the right heart chambers with preserved left ventricular (LV) function. Patients with PH associated with CHF of ischemic genesis showed significant changes in the left heart chambers (increased LV size and volume, low LV ejection fraction, LV diastolic dysfunction), moderate pulmonary hypertension, and significant increase in pulmonary artery wedge pressure.
Conclusion. Current study revealed significant differences in clinical and anamnestic data, structural and functional parameters of the right and left heart chambers, and approaches to treating patients with different forms of PH. PAH-specific therapy was used only in IPAH patients, while in patients with PAH associated with of CHF of ischemic genesis, treatment was aimed at optimizing the therapy of heart failure. Differentiated approach to the diagnosis and treatment of PH helps to improve the prognosis and life quality of patients.
Keywords
idiopathic pulmonary arterial hypertension
chronic heart failure
ischemic genesis
transvenous cardiac catheterization
PAH-specific therapy
References
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About the Authors
Elena A. Devetyarova, MD, postgraduate student of the Department of internal medicine No. 1, Rostov State Medical University of the Ministry of Healthcare of Russia, cardiologist at the Cardiology Department, Rostov Regional Clinical Hospital. Address: 344015, Rostov-on-Don, 170 Blagodatnaya St.E-mail: helendiamond@yandex.ru
ORCID: https://orcid.org/0000-0001-7094-2034. eLibrary SPIN: 8491-3721
Anna I. Chesnikova, MD, Dr. Sci. (Medicine), professor, head of the Department of internal medicine No. 1, Rostov State Medical University of the Ministry of Healthcare of Russia. Address: 344022, Rostov-on-Don, 29 Nakhichevansky Lane.
E-mail: rostov-ossn@yandex.ru
ORCID: https://orcid.org/0000-0002-9323-592X. Scopus ID: 55344352600. eLibrary SPIN: 9677-0932
Anastasia V. Dyuzhikova, MD, PhD (Medicine), physician at the Department of ultrasound diagnostics, Rostov Regional Clinical Hospital. Address: 344015, Rostov-on-Don, 170 Blagodatnaya St.
E-mail: dyuzhikova.a@bk.ru
ORCID: https://orcid.org/0000-0002-4112-9295
Olga E. Kolomatskaya, MD, PhD (Medicine), associate professor of the Department of internal medicine No. 1, Rostov State Medical University of the Ministry of Healthcare of Russia. 344022, Rostov-on-Don, 29 Nakhichevansky Lane.
E-mail: okolomackaya@mail.ru
ORCID: https://orcid.org/0000-0003-2888-3194. Scopus ID: 57210175260. eLibrary SPIN: 1185-7348
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