Professional chronic obstructive pulmonary disease in combination with heart failure — clinical and functional features

Introduction. Heart failure increases the severity of symptoms and worsens the prognosis of chronic obstructive pulmonary disease (COPD) in smokers. Professional COPD is a separate phenotype, which suggests dif erences in the pat ern of comorbidity. Professional COPD in combination with heart failure has not been studied enough.
T e aim of the study was to determine the relationship of heart failure c clinical, functional and hygienic characteristics of professional COPD.
Materials and methods. T e one-center observational study included 115 patients with occupational chronic obstructive pulmonary disease (OCOPD). T e comparison group of 103 patients with COPD, smokers of tobacco. T e diagnosis of COPD met the criterion of GOLD 2011–2019. OCOPD patients were exposed to aromatic hydrocarbons with an excess of MPC in the air of working zone is 1.5 to 6 times, or of inorganic dust in the range of 2 to 9.5 MPC. Heart failure was diagnosed on the basis of any signs of myocardial dysfunction in echocardiography and/or elevation of the N-terminal precursor of cerebral natriuretic peptide (NT-pro-BNP) serum more than 125 PG/ml. the Groups were comparable in sex, age, durationof COPD, duration of action of exogenous etiological factor, causes of heart failure. Clinical and functional characteristics of COPD and heart failure were evaluated. For comparisons between groups for quantitative parameters used covariance analysis or test Kruskall-Wallis for comparison, the share of χ2 criterion. Relationships were determined by logistic regression.
Results. In patients with OCOPD, the heart failure rate was higher  — 63 (54.8%) cases compared to 38 (36.9%) in the group of COPD Smoking (p=0.009). Biventricular failure prevailed (44 (38.3%) patients) with preserved ejection fraction(47 (40.9%) cases). Right ventricular failure was detected in 15 (13.0%) of the subjects, lef ventricular failure — in 4 (3.5%), p=0.002. Echocardiography revealed severe pulmonary hypertension and diastolic myocardial dysfunction in the OCOPD group. OCOPD in combination with heart failure was characterized by CAT index values of more than 10 points, low exercise tolerance, a signif cant rate of decline in FEV1, a decrease in the partial tension of arterial blood oxygen, severe exacerbations of COPD. In multivariate analysis of the development of heart failure in patients with OCOPD predicted: length of service, systolic pressure in the pulmonary artery, partial oxygen tension of arterial blood, the test distance of six-minute walk.
Conclusions. 1. OCOPD is characterized by a probability of heart failure — 54.8%. Biventricular failure with preserved ejection f action and predominant violation of diastolic myocardial function prevails. 2. T e subphenotype of OCOPD in combination with heart failure is characterized by severe symptoms, hypoxemia of rest, severe exacerbations of COPD.

1. On the state of sanitary and epidemiological welfare of the population in the Russian Federation in the year 2017: State Report. Moscow, Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing; 2018 (in Russian).

2. Bukhtiyarov I.V. Izmerov N.F., Tikhonova G.I., Churanova A.N., Gorchakova T.Yu., Bryleva M.S., Krutko A.A. Work conditions as a risk factor mortality increase in able-bodied population. Med Tr Prom Ekol. 2017; 8:43–49 (in Russian).

3. Vasilyeva O.S., Kravchenko N.Yu. T e chronic obstructive disease of lungs as occupational illness: risk factors and problem of medical social rehabilitation of patients. Rossijskij medicinskij zhurnal. 2015; 21(5): 22–6 (in Russian).

4. Fishwick D., Sen D., Barber C., Bradshaw L., Robinson E., Sumner J. Occupational chronic obstructive pulmonary disease: a standard of care. Occupational medicine (Oxford, England). 2015; 65 (4): 270–82 DOI:10.1093/occmed/kqv019.

5. Chuchalin A.G., Khaltaev N., Antonov N.S., Galkin D.V., Manakov L.G., Antonini P. et al. Chronic respiratory diseases and risk factors in 12 regions of the Russian Federation. International journal of chronic obstructive pulmonary disease. 2014; 9: 963–74 DOI: 10.2147/COPD.S67283.

6. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2019 reprot). https://goldcopd.org/wp-content/uploads/2018/11/GOLD–2019-v1.7-FINAL–14Nov2018-WMS. pdf

7. Carter P., Lagan J., Fortune C., Bhat D.L., Vestbo J., Niven R. et al. Association of Cardiovascular Disease With Respiratory Disease. J Am Coll Cardiol. ht ps://www.sciencedirect.com/science/article/pii/S0735109719304577?via%3Dihub DOI: 10.1016/j.jacc. 2018.11.063.

8. Parrinello G., Torres D., Buscemi S., Di Chiara T., Cut it a F., Cardillo M. et al. Right ventricular diameter predicts all-cause mortality in heart failure with preserved ejection fraction. Intern Emerg Med ht ps://link.springer.com/article/10.1007%2Fs11739–019–02071-x DOI: 10.1007/s11739–019–02071-x.

9. Serebryakov P.V., Kartashev O.I., Fedina I.N. Clinical and hygienic evaluation of health state of copper production workers in Far North. Med Tr Prom Ekol. 2016; 1: 25–8 (in Russian).

10. Shpagina L.A., Kotova O.S., Saraskina L.E., Ermakova M.A. Peculiarities of cellular molecular mechanisms of occupational chronic obstructive pulmonary disease. Sib. med. obozrenie. 2018; (2): 37–45 DOI: 10.20333/2500136–2018–2–37–45.

11. Rodríguez E., Ferrer J., Zock J.P., Serra I., Antó J.M., de Batlle J. et al. Lifetime occupational exposure to dusts, gases and fumes is associated with bronchitis symptoms and higher dif usion capacity in COPD patients. PLoS One. 2014; 9 (2): e88426. DOI: 10.1371/journal. pone. 0088426.

12. Mareev V.Yu. Fomin I.V. Ageev F.T. Begrambekova Yu.L. Vasyuk Yu.A. Garganeeva A.A. et al. Clinical guidelines OSSN — RCO — RSMOT. Heart failure: chronic and acute decompensated. Diagnosis, prevention and treatment. Kardiologiya. 2018; 58(S6): 1–164 (in Russian).

13. Chuchalin A.G., Avdeev S.N., Ajsanov Z.R., Belevskij A.S., Leshchenko I.V., Ovcharenko S.I., SHmelev E.I. Russian Respiratory Society. Сhronic obstructive pulmonary disease. Federal guidelines. Available at: ht p://spulmo.ru/obrazovatelnye-resursy/federalnye-klinicheskie-rekomendatsii/ (in Russian).

14. Portillo K., Torralba Y., Blanco I., Burgos F., RodriguezRoisin R., Rios J. et al. Pulmonary hemodynamic prof le in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2015; 10: 1313–20. DOI: 10.2147/COPD.S78180.

15. Barnes PJ. Inflammatory mechanisms in patients with chronic obstructive pulmonary disease. J Allergy Clin Immunol. 2016; 138 (1): 16–27 DOI: 10.1016/j.jaci. 2016.05.011.

16. Hohlfeld J.M., Vogel-Claussen J., Biller H., Berliner D., Berschneider K., Tillmann H.C., et al. Ef ect of lung def ation with indacaterol plus glycopyrronium on ventricular f lling in patients with hyperinf ation and COPD (CLAIM): a double-blind, randomised, crossover, placebo-controlled, single-centre trial. Lancet Respir Med. 2018; 6(5): 368–78 DOI: 10.1016/S2213–2600(18)30054–7.

17. Zyubina L.Yu., Shpagina L.A., Panacheva L.A. Industrially mediated hemopathies and occupational diseases of blood. Med. truda i prom. ekol. 2008; 11: 15–20 (in Russian)

18. Montani D., Lau E.M., Descatha A., Jaïs X., Savale L., Andujar P., et al. Occupational exposure to organic solvents: a risk factor for pulmonary veno-occlusive disease. Eur Respir J. 2015;46(6): 1721–31. DOI: 10.1183/13993003.00814–2015.

19. Zelko I.N., Zhu J., Roman J. Role of SOD3 in silica-related lung f brosis and pulmonary vascular remodeling. Respir Res. 2018; 19 (1): 221 DOI: 10.1186/s12931–018–0933–6.

20. Giezeman M., Hasselgren M., Lisspers K., Ställberg B., Montgomery S., Janson C., Sundh J. Inf uence of comorbid heart disease on dyspnea and health status in patients with COPD — a cohort study. Int J Chron Obstruct Pulmon Dis. 2018; 13: 3857–65. DOI: 10.2147/COPD.S175641.

21. Westerik J.A., Met ing E.I., van Boven J.F., Tiersma W., Kocks J.W., Schermer T.R. Associations between chronic comorbidity and exacerbation risk in primary care patients with COPD. Respir Res. 2017; 18 (1): 31 DOI: 10.1186/s12931–017–0512–2.