Features of central hemodynamics in patients with community - acquired pneumonia depending on the course of the disease and cardiovascular comorbidity

Abstract

Aim. The study of intracardiac hemodynamics and blood flow in the pulmonary circuit in patients with community - acquired pneumonia, depending on the presence of concomitant pathology of the cardiovascular system and the severity of the pathological process. Materials and methods. In 43 patients with community - acquired pneumonia (22 men, 21 women, mean age 67±17 years), the functional state of pulmonary - cardiac hemodynamics was assessed by echodoplerography. All subjects were divided into 2 groups: 1st group - 25 patients with community - acquired pneumonia (mean age 49±18 years) without concomitant pathology of the cardiovascular system and 2nd group - 18 patients with community - acquired pneumonia (mean age 70.1±11 years) with concomitant cardiovascular disease. Results. The main ultrasound parameters did not differ from the normal values in patients from the 1st group. In patients from the 2nd group there was a significant deterioration of several pulmonary - cardiac hemodynamics parameters, decrease of left ventricular ejection fraction, significant myocardial hypertrophy of the left ventricle and left atrium size increase. Regarding the right heart chambers it was revealed dilatation of the right ventricle, increasing of the estimated systolic pressure in the right ventricle, deterioration of right ventricle myocardial diastolic function, increase of the: RV/LV size ratio, LV eccentricity index, RV myocardium thickness, diameter of the pulmonary artery, velocity of pulmonary regurgitation and the area right atrium size. In addition, the amplitude of systolic displacement of the tricuspid valve ring and the intensity of inspiratory collapse of the inferior vena cava decreased. Correlation analysis of clinical and laboratory parameters, which are markers of endogenous intoxication, oxygen saturation of arterial blood (SpO2), separately for two groups of patients with community - acquired pneumonia, showed a reliable correlation with a number of informative and used in the practice echocardiography parameters of pulmonary cardiac hemodynamics, characterizing systolic (systolic movement amplitude of the tricuspid valve ring - TAPSE), as well as diastolic function (E/A of the right ventricle) of the heart. Conclusion. The relationship between the severity of pulmonary - cardiac hemodynamics disturbances in patients with community - acquired pneumonia, having comorbid pathology, contributing to the deterioration of pulmonary - cardiac hemodynamics and more severe course of the disease with markers of the inflammatory process and oxygen saturation of arterial blood decrease is revealed.