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Study of effect of therapy of chronic obstructive pulmonary disease on coexistent chronic heart failure

Session Poster Session 3

Speaker Samir Morcos Rafla

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Pharmacotherapy
  • Session type : Poster Session

Authors : SAMIR Rafla (Alexandria,EG), ALY Aboelhoda (Alexandria,EG), AZZA Khamis (Alexandria,EG), RANIA Swied (Alexandria,EG)

Authors:
SAMIR Rafla1 , ALY Aboelhoda1 , AZZA Khamis1 , RANIA Swied1 , 1Alexandria University, Faculty of Medicine - Alexandria - Egypt ,

Citation:

The aim of this study was to determine the impact of chronic obstructive pulmonary disease treatment on the clinical condition of patients with heart failure. Forty Patients were enrolled in this study with co-existent heart failure (EF < 50%) with chronic obstructive pulmonary disease. Most of the studied patients (40%) were aged between 61 &70 years old. Smoking cessation: 25 patients stopped smoking (62.5%), and 15 patients didn't stop smoking (37.5%). Risk factors: Among studied cases, 34 cases (85%) suffered from systolic hypertension, 18 cases (45%) suffered from diabetes, and 28 cases (70%) had dyslipidemia. All patients were smoker (97.5%) except 1 patient was passively smoking and 17 patients were NYHA class III (42.5%), 23 patients were NYHA class II. Mean body mass index was 29.2 ± 6 kg/ m2. ECG findings: Among studied patients, ischemic changes in ECG were present in 37 cases (92.5%).

Methods: Spirometry: The following results were obtained: FEV1: (Forced Expiratory Volume in one second), FVC: (Forced Vital Capacity), FEV1/FVC ratio, FEF 25-75%: (Forced Expiratory Flow between 25-75% of vital capacity), PEF (peak expiratory flow). Echocardiography was done. All patients were on treatment for heart failure and for COPD. Patients were followed for two months, and then echocardiography and spirometry were repeated for assessment of LV function and respiratory functions. Drugs given angiotensin blockers in 90%, beta-blockers (selective) in 94%, Sympathomimetics (long-acting ß2-agonist LABA) in 100%, long-acting muscarinic antagonist (LAMA) in 55%; Figure. Results: Echo data Baseline EF ranged from19 to 50 % with a mean 32.7 ± 9.1. Two months later, EF ranged from 19.3 – 56.6% with a mean 36.18 ± 10 showing obvious improvement after addition of COPD treatment to patients on anti-failure treatment. Right ventricular systolic pressure (RVSP) ranged from 18.0 – 86.0 mmHg in baseline echocardiography assessment with a mean 47.9 ± 18.7.  Two months later, follow up echo showed (RVSP) ranged from 16 – 81 mmHg with a mean 45.40 ± 18.0 showing obvious improvement after addition of COPD treatment to patients on anti-failure treatment. Spirometry Data: FVC ranged from 0.55 – 2.60 liters in pre-treatment of COPD with a mean 1.31 ± 0.52. Two months later, F VC ranged from 0.36 – 2.84 liters with a mean 1.62 ± 0.59 showing obvious improvement after addition of COPD treatment to patients on anti-failure treatment.

EF improved in 25 patients in whom COPD improved in all, EF did not improve in 15, in whom COPD did not improve also.  All patients who stopped smoking had improvement in EF and COPD; all who did not stop smoking had no improvement in both parameters. Conclusions: Improvement of COPD is associated with improvement of heart failure. Cessation of smoking is the best marker of possible improvement of both diseases. The use of sympathomimetics as inhalers or tablets had no deleterious effect on cardiac function.

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