rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2018-14-3-379-386rpcardio-1693Research ArticleASSOCIATED PROBLEMS OF CARDIOLOGYСМЕЖНЫЕ ВОПРОСЫ КАРДИОЛОГИИRECENT ASPECTS OF CARDIAC REMODELING IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASEСОВРЕМЕННЫЕ АСПЕКТЫ РЕМОДЕЛИРОВАНИЯ СЕРДЦА У БОЛЬНЫХ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНЬЮ ЛЕГКИХЛиВ. В.LeeV. V.

д.м.н., профессор, кафедра поликлинической терапии,

 127473, Москва, ул. Делегатская, 20/1

MD, PhD, Professor, Chair of Polyclinic Therapy,

Delegatskaya ul. 20/1, Moscow, 127473

vera0212@yandex.ruТимофееваН. Ю.TimofeevaN. Yu.

к.м.н., доцент, кафедра поликлинической терапии,

 127473, Москва, ул. Делегатская, 20/1

MD, PhD, Associate Professor, Chair of Polyclinic Therapy,

Delegatskaya ul. 20/1, Moscow, 127473

ЗадионченкоВ. С.ZadionchenkoV. S.

д.м.н., профессор, кафедра поликлинической терапии,

 127473, Москва, ул. Делегатская, 20/1

MD, PhD, Professor, Chair of Polyclinic Therapy,

Delegatskaya ul. 20/1, Moscow, 127473

АдашеваТ. В.AdashevaT. V.

д.м.н., профессор, кафедра поликлинической терапии,

 127473, Москва, ул. Делегатская, 20/1

MD, PhD, Professor, Chair of Polyclinic Therapy,

Delegatskaya ul. 20/1, Moscow, 127473

ВысоцкаяН. В.VysotskayaN. V.

аспирант, кафедра поликлинической терапии,

 127473, Москва, ул. Делегатская, 20/1

MD, Post-Graduate Student, Chair of Polyclinic Therapy,

Delegatskaya ul. 20/1, Moscow, 127473

Московский государственный медико-стоматологический университет им. А.И. ЕвдокимоваРоссияA.I. Evdokimov Moscow State University of Medicine and DentistryRussian Federation201804072018143379386Copyright © Lee V.V., Timofeeva N.Y., Zadionchenko V.S., Adasheva T.V., Vysotskaya N.V., 20182018Ли В.В., Тимофеева Н.Ю., Задионченко В.С., Адашева Т.В., Высоцкая Н.В.Lee V.V., Timofeeva N.Y., Zadionchenko V.S., Adasheva T.V., Vysotskaya N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/1693

The paper aimed to present evidence of the effect of some pathophysiological features of chronic obstructive pulmonary disease (COPD) on cardiac remodeling in patients free of overt cardiovascular diseases, traditional cardiovascular risk factors and pulmonary hypertension. Contrary to traditional beliefs that cardiac abnormalities in COPD have been mainly associated with the right ventricle, several recent studies have shown an independent effect of pulmonary hyperinflation and emphysema on left ventricular (LV) diastolic filling and LV hypertrophy. Pulmonary hyperinflation and emphysema cause intrathoracic hypovolemia, low preload, small end-diastolic dimension and mechanical compression of LV chamber which could worsen end-diastolic stiffness. Interestingly, that the presence of LV hypertrophy in COPD patients is important but currently poorly understood area of investigation. Pulmonary hyperinflation, increased arterial stiffness and sympathetic activation may be associated with LV hypertrophy. Two-dimensional ultrasound speckle tracking studies have shown the presence of sub-clinical LV systolic dysfunction in patients even with moderate COPD and free of overt cardiovascular diseases. Sarcopenia related to the inflammatory-catabolic state in COPD and hypoxia could play an important role regarding LV systolic dysfunction. Recent data reported the effects of long-acting bronchodilators on reducing lung hyperinflation (inducing lung deflation). Further studies are required to evaluate the effects of pharmacological lung deflation therapy on cardiac volume and function.

В обзорной статье обсуждаются современные данные о влиянии патофизиологических характеристик хронической обструктивной болезни легких (ХОБЛ) на ремоделирование сердца при отсутствии сопутствующих сердечно-сосудистых заболеваний, факторов сердечно-сосудистого риска и хронической легочной гипертензии. Вопреки традиционным представлениям о преимущественном вовлечении в патологический процесс правых камер сердца у больных ХОБЛ результаты ряда исследований, проведенных в последние годы, свидетельствуют о непосредственном участии легочной гиперинфляции и эмфиземы в нарушениях диастолического наполнения и морфологических параметров левого желудочка (ЛЖ). Основным механизмом диастолической дисфункции ЛЖ у больных ХОБЛ с выраженной гиперинфляцией и эмфиземой является снижение преднагрузки на фоне ремоделирования легочного сосудистого русла, механическая компрессия камер сердца, которая повышает ригидность миокарда. Интересными, малоизученными и противоречивыми остаются вопросы гипертрофии миокарда ЛЖ у больных ХОБЛ без сопутствующей кардиальной патологии – легочная гиперинфляция, повышение жесткости сосудистой стенки и активация симпатоадреналовой системы рассматриваются в качестве возможных факторов ее развития. Применение спекл-трекинг эхокардиографии позволяет выявлять субклинические нарушения систолической функции ЛЖ у больных ХОБЛ уже при умеренной степени бронхиальной обструкции и без сердечно-сосудистых заболеваний. К значимым патофизиологическим механизмам формирования систолической дисфункции относятся саркопения, обусловленная активацией системных воспалительных реакций с развитием нарушений энергетического обмена, и хроническая гипоксия. Современная бронходилатирующая терапия ХОБЛ позволяет уменьшать выраженность легочной гиперинфляции, в связи с чем необходимо активное изучение возможности воздействия фармакологической редукции легочных объемов на замедление развития и прогрессирования дисфункции миокарда.

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The authors declare that there are no conflicts of interest present.