Ventricular rhythm disturbances during computer spirography in patients with stable ischemic heart disease and chronic obstructive pulmonary disease: clinical and functional predictors of occurrence

Abstract

The purpose of the study is to determine the predictors of cardiac rhythm disturbance during spirography in patients with a combination of stable coronary heart disease and chronic obstructive pulmonary disease. Materials and methods. The study included 53 patients with a combination of stable ischemic heart disease and chronic obstructive pulmonary disease, 53 patients with stable ischemic heart disease without concomitant chronic obstructive pulmonary disease, and 42 patients with chronic obstructive pulmonary disease without ischemic heart disease. Cardiac rhythm disturbances during spirography were examined by synchronous determination of the external respiration function and 24-hour Holter ECG monitoring, predictors of high grade ventricular extrasystoles appearance in patients with combined pathology were calculated. Results. It has been established that 20.7 % of patients with a combination of stable ischemic heart disease and chronic obstructive pulmonary disease have high grade ventricular extrasystoles (P = 0.008) during spirography, whereas among patients with isolated ischemic heart disease – 9.4 %, among people with chronic obstructive pulmonary disease – 7.1 %. The chances of high grade ventricular extrasystoles occurring during spirography are 5.7 times more in patients with a combined course of stable ischemic heart disease and chronic obstructive pulmonary disease in case of the left atrial size of more than42.9 mm, 3.93 times in case of end-systolic volume of the left ventricle of more than 76.1 ml, 6.7 times if the left ventricular ejection fraction of less than 49.1 %, 43.3 times if the patient has more than 1319 ventricular extrasystoles during the day, 2.37 times in the presence of more than 12.3 ventricular bigeminy per day; if the maximum heart rate is increased during the active period or over one day more than 95.5 beats/min and 106.9 beats/min, chances are 2.77 and 3.23 times increased, respectively. Conclusions. Patients with a combination of stable ischemic heart disease and chronic obstructive pulmonary disease differ from those with an isolated course of pathologies in the incidence of ventricular rhythm disorders during spirography. To assess the risk of developing high grade ventricular extrasystoles for patients with combined pathology, additional examinations should be performed before spirography, namely 24-hour Holter ECG monitoring and echocardiography.

Keywords

• myocardial ischemia
• chronic obstructive pulmonary disease
• spirography
• diagnosis