[Diagnosis of pulmonary heart in patients with chronic obstructive pulmonary disease]

Informative value of clinical, electrocardiographic, and echocardiographic diagnostic criteria of compensated chronic pulmonary heart (CPH) in patients with chronic obstructive pulmonary disease (COPD) was considered. The study included 229 patients with COPD of which 105 (group 1) showed no signs of CPH, 71 (group 2) had compensated and 53 (group 3) uncompensated CPH. They were examined by the standard echoCG method using an Acuson-128 HR apparatus (USA) and 12-lead ECG during a 2 year-long follow-up period. Direct cardiac clinical and electrocardiographic signs of right ventricular eccentric hypertrophy were found to have high informative value (100%) but very low sensitivity (7-53%). Indirect diagnostic criteria of compensated CHP are such non-specific signs as age of COPD patients above 50 yr, duration of the disease over 8 yr and broncho-obstructive syndrome (episodes of low-productive cough, dyspnea under small physical load and at rest, X-ray signs of lung emphysema, substantial reduction of FEV and FEV/FVC ratio) in 73-94% of the patients were associated with compensated CPH. The most valuable (75.8-90.5%) cardiographic diagnostic criteria for compensated CPH were MPAP > 22 mmHg (at rest), LVEDD > 24 mm, LVEDS > 17 mm, RVWT = > 5 mm, RAEDD > 32 mm. Criterion LVEDD > 24 mm has the optimal ratio of sensitivity (94.4%), specificity (85.7%), and positive predictive value (86.6%). Comprehensive clinical assessment of COPD character and duration, patients' age, manifestation of broncho-obstructive syndrome and direct clinical signs suggesting involvement of the right half of the heart permits to predict CPH in patients with COPD with a probability of 75%. The definitive diagnosis is verified by echoCG or other instrumental methods.