PULMONARY HYPERTENSION IN PATIENTS WITH RHEUMATIC HEART DISEASE

Aim. Assessment of contribution of pulmonary hypertension (PH) especially the manifestations of chronic rheumatic heart disease (RHD). Materials and Methods. 191 patients with RHD were examined: 31 men and 160 women. PH was detected in 119 patients (62.3%); 72 patients (37.7%) were patients without PH. Echocardiography was performed on a Philips Affinity 50 apparatus, spirography on Spirolab II. Evaluation of functional class (FC) of chronic heart failure (CHF) was performed using the 6-minute walk test. Results. The distance of the 6-minute walk test in the group with PH is less (305.61±10.70 m) than in the group without PH (358.05±9.73 m) against the background of a smaller area of the mitral orifice (1.76±0.12 cm2) in comparison with those tested without PH (2.36±0.12 cm2). On echocardiography, patients with PH had significantly increased linear dimensions of the left (up to 5.40±0.26 cm) and right atrium (up to 5.16±0.24 cm), right ventricle (up to 2.85±0.09 cm). The values of spirometry in the group without PH were within normal limits. And in those studied with RHD with PH, obstructive indices decreased first of all (FVC – 71.20±2.57%, FEV1 – 77.46±2.74%). For most of the total scales of the quality of life questionnaires (SF-36, MHFLQ), there was no difference between the groups. Only the indicators of the KCCQ scale of the total clinical questionnaire (46.58±2.40 and 53.57±3.63 RHD without PH) and the scale values of the EQ-5D questionnaire (55.93±2.59 RHD without PH and 51.00±2.91 RHD with PH). No contribution of PH to anxiety and depressive disorders was found, although, in general, subclinical anxiety and depression were observed in the study subjects with RHD in both groups. Conclusion. In patients with RHD, against the background of a narrowing of the mitral orifice to 1.76±0.12 cm2, PH is formed, accompanied by large linear dimensions of the atria and right ventricle. Also, patients with PH had a shorter 6-minute walk test distance of 52.44 meters within II FC CHF. These changes are accompanied by a decrease in the indices of respiratory function of obstructive and restrictive types. At the same time, no changes in the quality of life and manifestations of anxiety and depression between groups of patients were revealed.