From endothelial dysfunction correction to macrohemodynamics improvement in patients with chronic cor pulmonale

Abstract

Aim. To investigate the features of endothelial function, apoptosis, micro- and macrohemodynamics in patients with chronic obstructive pulmonary disease (COPD) and chronic cor pulmonale (CCP), as well as to study the effects of a highly selective beta-1-adrenoblocker (B-1-AB) nebivolol on these parameters..Material and methods. The study included 38 COPD patients with CCP (26 and 12 with CCP decompensation and compensation, respectively), aged 46-77 years. All participants received not only COPD and CCP therapy, but also an ACE inhibitor nebivolol (2.5-5 mg once a day) for 6 months.Results. CCP patients were characterised by substantial endothelial dysfunction (ED), pathological NO hyper-production, elevated level of Willebrand factor, and increased apoptosis. Additionally, hypercoagulation, platelet hyper-aggregation, and heart systolic and diastolic dysfunction were observed. Nebivolol therapy was associated with reduced NO hyper-production: in plasma — to 13,34±1,44 mkm (p<0,01) in CCP compensation and to 18,86±1,23 mkm (p<0,001) in CCP decompensation; in exhaled air — to 11,4±1,07 mkm (p<0,001) and 24,57±1,14 mkm (p<0,001), respectively. Reduced Willebrand factor levels and pathological apoptosis activity, as well as improved blood rheology and central hemodynamics, were also observed.Conclusion. CCP in COPD patients aggravates the clinical course and the prognosis of the disease. ED is one of the main mechanisms of CCP development and progression. Nebivolol therapy, as a part of complex CCP man­agement, improves central hemodynamics, blood rheology, endothelial function, decreases pathological apoptosis activity and therefore reduces CCP progression.

Keywords

• хроническое легочное сердце
• эндотелиальная дисфункция
• апоптоз
• оксид азота
• небиволол