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.

1. Mareev V.Yu., Fomin I.V., Ageev F.T., Arutiunov G.P., Begrambekova Yu.L., Belenkov Yu.N. et al. Clinical guidelines. Chronic heart failure (CHF). Russian Heart Failure Journal. 2017;18(1):3–40. DOI: 10.18087/rhfj.2017.1.2346

2. Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJV. Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. European Journal of Heart Failure. 2009;11(2):130–9. DOI: 10.1093/eurjhf/hfn013

3. De Miguel-Díez J, Chancafe Morgan, Jimenez-Garcia. The association between COPD and heart failure risk: a review. International Journal of Chronic Obstructive Pulmonary Disease. 2013;8:305–12. DOI: 10.2147/COPD.S31236

4. Authors/Task Force Members, Camm AJ, Lip GYH, De Caterina R, Savelieva I, Atar D et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. EP Europace. 2012;14(10):1385–413. DOI: 10.1093/europace/eus305

5. Leonova E.I., Shehan G.G., Zadionchenko V.S., Bogatyrova K.M. Atrial fibrillation in patients with chronic obstructive pulmonary disease. Rational Pharmacotherapy in Cardiology. 2014;10(3):328–33.

6. Nekrasov A.A., Kuznetsov A.N., Melnichenko O.V., Kruglova I.S. The cardiac remodeling of patients with chronic obstructive pulmonary disease. Medical Almanac. 2011;3(16):112–5.

7. Koziolova N.A., Nikonova Yu.N., Shilova Ya.E., Agafonov A.V., Polianskaya E.A. Description of chronic heart failure against the background of permanent atrial fibrillation. Russian Heart Failure Journal. 2013;14(1):14–21. DOI: 10.18087/rhfj.2013.1.1806

8. Mashina T.V., Golukhova E.Z. Left ventricular diastolic dysfunction in patients with atrial fibrillation: pathogenetic mechanisms and modern ultrasound estimation techniques (an analytical review). Creative Cardiology. 2014;4:43–52.

9. Drapkina O.M., Emelyanov A.V. Atrial fibrosis is a morphological basis of atrial fibrillation. Rational Pharmacotherapy in Cardiology. 2013;9(4):417–9.

10. Burnashkina O.N., Selezneva N.M., Kotlyarov A.A. Changes in some hemodynamic parameters in obstructive pulmonary diseases. The Eurasian Union of Scientists (ESU). 2015;7–3(16):28–31.

11. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography. 2015;28(1):1-39.e14. DOI: 10.1016/j.echo.2014.10.003

12. Sumin A.N., Arkhipov O.G. Right ventricular diastolic function in patients with lung diseases in the absence or presence of pulmonary hypertension. Therapeutic Archive. 2017;89(3):54– 60. DOI: 10.17116/terarkh201789354-60

13. Melnichenko O.V., Nekrasov A.A., Kuznetsov A.N. Factors associated with the development of atrial fibrillation in chronic obstructive pulmonary disease. International Journal of Biomedicine. 2011;1(2):71–3

14. Qureshi W, Soliman EZ, Solomon SD, Alonso A, Arking DE, Shah A et al. Risk Factors for Atrial Fibrillation in Patients with Normal Versus Dilated Left Atrium (from the Atherosclerosis Risk in Communities Study). The American Journal of Cardiology. 2014;114(9):1368–72. DOI: 10.1016/j.amjcard.2014.07.073