Особенности кардиопульмонального резерва у больных хронической тромбоэмболической легочной гипертензией с сопутствующими нарушениями ритма

Вклад авторов. Все авторы соответствуют критериям авторства ICMJE, принимали участие в подготовке статьи, наборе материала и его обработке. Авторский вклад (по системе Credit): Клинкова А.С. – методология, проведение исследования, создание рукописи и её редактирование, визуализация; Каменская О.В. – концептуализация, методология, администрирование проекта; Логинова И.Ю. – верификация данных, формальный анализ, проведение исследования, создание черновика рукописи; Поротникова С.С. – формальный анализ, проведение исследования, администрирование данных; Волкова И.И. – ресурсы; Доронин Д.В. – ресурсы; Чернявский А.М. – руководство исследованием, администрирование проекта.

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

Информация о соблюдении этических норм. Исследование проведено в соответ- ствии со стандартами надлежащей клинической практики (Good Clinical Practice) и принципами Хельсинской Декларации. Протокол исследования одобрен местным Этическим комитетом; протокол заседания №32 от 21.09.2022 г. До включения в исследование у всех пациентов было получено письменное информированное согласие.

Прозрачность финансовой деятельности. Данная работа была выполнена в рамках государственного задания Министерства здравоохранения Российской Федерации № 124022000090-0.

Данная статья распространяется на условиях «открытого доступа», в соответствии с лицензией CC BY-NC-SA 4.0 («Attribution-NonCommercial-ShareAlike» / «Атрибуция-Не-коммерчески-Сохранение Условий» 4.0), которая разрешает неограниченное некоммерческое использование, распространение и воспроизведение на любом носителе при условии указания автора и источника. Чтобы ознакомиться с полными условиями данной лицензии на русском языке, посетите сайт: by-nc-sa/4.0/

UDC 612.172.2+612.172.1+616-005.755LBC 54.10

ORIGINAL ARTICLE

*1) Check for updates

*Asya S. Klinkova ¹ , Oksana V. Kamenskaya ¹ , Irina Yu. Loginova ¹ , Svetlana S. Porotnikova ¹ , Irina I. Volkova ' , Dmitrij V. Doronin i , Аlexander М. Chernyavskiy i , ²

FEATURES OF CARDIOPULMONARY RESERVE IN PATIENTS WITHCHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSIONWITH CONCOMITANT RHYTHM DISTURBANCES

‘E.N. M eshalkin N ational M edical R esearch C enter , 15 R echkunovskaya street , N ovosibirsk 630055, R ussian F ederation ;

Novosibirsk S tate M edical U niversity of the M inistry of H ealth of the R ussian F ederation ,

52 K rasny P rospect S treet , N ovosibirsk , 630091, R ussian F ederation

*Corresponding author: Asya S. Klinkova , Cand. of Sc. (Med.), researcher, Laboratory of Clinical Physiology, Research Department of anesthesiology and critical care medicine, E.N. Meshalkin National Medical Research Center, 15 Rechkunovskaya street, Novosibirsk 630055, Russian Federation, e-mail: asya465@yandex. ru, ORCID: 0000-0003-2845-930X

Oksana V. Kamenskaya , Dr. of Sc. (Med.), Head of the Laboratory of Clinical Physiology, Research Department of anesthesiology and critical care medicine, E.N. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation, ORCID: 0000-0001-8488-0858

Irina Yu. Loginova , Cand. of Sc. (Biol.), researcher, Laboratory of Clinical Physiology, Research Department of anesthesiology and critical care medicine, E.N. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation, ORCID: 0000-0002-3219-0107

Svetlana S. Porotnikova , researcher, Laboratory of Clinical Physiology, Research Department of anesthesiology and critical care medicine, E.N. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation, ORCID: 0000-0002-0061-2205

Irina I. Volkova , Cand. of Sc. (Med.), doctor of functional diagnostics, Head of the Department of Functional Diagnostics, E.N. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation, ORCID: 0000-0001-6575-9008

Dmitrij V. Doronin , Cand. of Sc. (Med.), Cardiologist, Cardiac surgery department No. 2, E.N. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation, ORCID: 0000-0003-3372-2889

Alexander M. Chernyavskiy , Dr. of Sc. (Med.), Professor, General Director, General Director, E.N. Meshalkin National medical research center; Head of the Department of Cardiovascular Surgery, Novosibirsk State Medical University, Novosibirsk, Russian Federation, ORCID: 0000-0001-9818-8678

Aim. To study the characteristics of cardiopulmonary reserve in patients with chronic thromboembolic pulmonary hypertension (CTEPH) with concomitant atrial fibrillation (AF) and to evaluate the relationship between the level of peak oxygen consumption (V ' 0 2 peak) and the course of the hospital period after pulmonary endarterectomy

Material and methods. A total of 124 male patients with CTEPH aged 52.8 (43.2–64.1) years were examined. 1st group (29 people) included patients with concomitant AF, and 2nd group (95 people) included patients without AF. Before surgery, patients underwent a cardiopulmonary exercise test (CPET).

Results. According to the CPET data, in the 1st group the values of V'02 peak, V'02 peak at the anaerobic threshold, V'02/HR peak, threshold power and duration of physical activity (PA) were lower in comparison with the 2nd (p<0.05). The ventilatory equivalent for carbon dioxide (V'E/V'CO2 peak) in the 1st group was higher than in the 2nd (p<0.05). Tolerance to PA in the 1st group was also lower in comparison with the 2nd group due to the lower threshold power and shorter duration of the load (p<0.05). V'02 peak values are inversely associated with the development of heart failure (OR 0.56 (0.36-0.82; p=0.002)), prolonged mechanical ventilation (OR 0.43 (0.34-0.71; p=0.001)) and hospital mortality in the early postoperative period (OR 0.82 (0.75-0.94; p=0.03)).

Conclusion. Patients with CTEPH with concomitant AF are characterized by lower reserves of the respiratory and cardiovascular systems compared to patients without AF due to lower values of V ' 0 2 peak, V ' 0 2 peak at the anaerobic threshold, V ' 0 2 /HR peak and a higher value of V ' E/V ' C0 2 peak. The comorbid group is characterized by lower tolerance to PA in comparison with the group without AF. V ' 0 2 peak values are inversely related to the development of heart failure, prolonged mechanical ventilation and hospital mortality in the early postoperative period.

Authors’ contributions. All authors meet the ICMJE criteria for authorship, participated in the preparation of the article, the collection of material and its processing. CRediT author statement: Asya S. Klinkova – methodology, investigation, writing – review & editing, visualization; Oksana V. Kamenskaya – conceptualization, methodology, project administration; Irina Yu. Loginova – validation, formal analysis, investigation, writing – original draft; Svetlana S. Porotnikova – formal analysis, investigation, data curation; Irina I. Volkova – resources; Dmitrij V. Doronin – resources; Аlexander М. Chernyavskiy – supervision, project administration.

Conflict of Interest. No conflict of interest to declare.

Ethical Compliance Information. The study was conducted in accordance with Good Clinical Practice standards and the principles of the Declaration of Helsinki. The study passed the independent local Ethics Committee; minutes of meeting No. 32 dated September 21, 2022. All study participants provided informed consent.

Financial disclosure. This work was carried out within the framework of the state task of the Ministry of Health of the Russian Federation No. 124022000090-0.