Clinical Features and the NT-proBNP Marker in Patients with Chronic Heart Failure in the Setting of Atrial Fibrillation and Chronic Obstructive Pulmonary Disease

Aim: To determine the clinical features and analyse the concentration of the heart failure (HF) marker in patients with atrial fi brillation (AF) and chronic obstructive pulmonary disease (COPD).

Materials and methods: 120 patients were divided into the following groups: 1) experimental group including patients with chronic heart failure (CHF), AF and COPD (n = 29); 2) comparison group 1 including patients with COPD, but without cardiovascular diseases (CVD) (n = 28); 3) comparison group 2 consisting of patients with CHF and COPD, but without AF (n = 30); 4) comparison group 3 comprising patients with CHF and AF, but without COPD (n = 33). Clinical symptoms and tolerance to physical load were assessed for all patients with CHF using the clinical condition scale (CCS) and the 6 Minute Walk Test (6MWT), respectively. The severity of dyspnoea was assessed (mMRC scale) in the groups of patients with COPD. The concentration of NT-proBNP was analysed using a Biomedica NT-proBNP reagent pack (SK-1204).

Results: A comparative analysis of the CHF clinical manifestations (according to CCS) in the study groups showed higher median values in the group of patients with CHF, AF and COPD, as compared to the same indicator in patients with CHF and AF, but without COPD (p < 0.001). An intergroup analysis of the dyspnoea symptom using the mMRC scale showed the lowest degree of dyspnoea in the group with COPD and without CVD, which signifi cantly differed from the same indicator in patients with CHF and COPD, but without AF (p = 0.015). The 6MWT results did not reveal signifi cant differences between the groups (p = 0.017). In assessing the level of the HF marker, higher concentrations of NT-proBNP were found in the group of patients with CHF, AF and COPD, which exceeded its concentration in patients with CHF and COPD, but without AF (p = 0.0003), as well as in patients with CHF and AF, but without COPD (p = 0.01).

Conclusion: 1. Due to the presence of chronic bronchial obstructive syndrome, higher severity of clinical HF symptoms was established in patients with CHF, AF and COPD – as compared to the group including patients with CHF and AF, but without COPD. 2. A statistically signifi cant higher level of NT-proBNP was determined in patients with CHF, AF and COPD, which is associated with the presence of hemodynamic load on both ventricles of the heart under the mutual infl uence of AF and chronic bronchial obstruction on the hemodynamics of the pulmonary circulation.