Limitación al flujo aéreo en pacientes con insuficiencia cardíaca: prevalencia y factores asociados

[Diagnostic and Prognostic Markers of Chronic Heart Failure in Patients with Occupational Chronic Obstructive Pulmonary Disease]

Aim      Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are a common comorbidity. Professional chronic obstructive pulmonary disease (PCOPD) is a specific phenotype, which suggests peculiarities in the development of HF. Difficulties of HF diagnosis in such patients determine the relevance of searching for additional markers. The aim of the study was identifying HF markers in patients with PCOPD.Material and methods  This single-site, cohort, prospective, observational study included 345 patients. The main group consisted of PCOPD patients; the comparison group consisted of patients with COPD induced by tobacco smoking; and the control group included conventionally healthy individuals. The groups were matched by the index of coincidence; pairs were matched at 1:1 by the "nearest neighbor index"; covariates for matching included COPD duration, sex, and age. Each group included 115 patients. The major professional adverse factors were silica-containing dust and organic solvents. COPD was diagnosed according to GOLD criteria; HF was diagnosed in accordance with Russian clinical guidelines. The markers were determined by multifactorial logistic regression. Likelihood of events with allowance for the time to the event was analyzed by the Kaplan-Meier method.Results HF in PCOPD patients was characterized by biventricular damage, preserved left ventricular ejection fraction, and frequent hospitalizations for decompensation (17.5 % vs. 9.5 % for COPD in smokers). HF markers in patients with PCOPD included the length of work of more than 20 years, pulmonary artery systolic pressure (PASP) higher than 35 mm Hg according to data of Doppler echocardiography, diffusing capacity of lungs for carbon monoxide (DLCO) less than 50 %, increased serum concentrations of CC-chemokine ligand 18 (CCL18), S-100‑beta protein, and N-terminal pro-brain natriuretic peptide (NT-pro-BNP). Diagnostic sensitivity of the multifactorial model was 84 % and specificity was 81 %. Two models were proposed for purposes of screening, which included the following parameters: length of work, exposure to aromatic hydrocarbons, decreased distance in 6-min walk test by more than 60 m per year and length of work, exposure to inorganic dust, and decreased forced expiratory volume during the first second by more than 55 ml per year.Conclusion      The markers for development of HF in PCOPD patients are length of work >20 years, PASP >35 mm Hg, DLCO <50 %, and increased serum concentrations of CCL18, S-100‑beta protein, and NT-pro-BNP.