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CNAA / Theses / 2017 / June /

Early diagnostic and treatment of pulmonary hypertension in patients with chronic obstructive pulmonary disease and mixed cardio-pulmonary pathology


Author: Martîniuc Constantin
Degree:doctor habilitat of medicine
Speciality: 14.00.26 - Phtisiopneumology
Year:2018
Scientific consultants: Sergiu Matcovschi
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Liviu Grib
doctor habilitat, associate professor (docent)
Institution: Public Medical Sanitary Intitution Institute of Phthisiopneumology "Chiril Draganiuc"

Status

The thesis was presented on the 7 June, 2017
Approved by NCAA on the 11 May, 2018

Abstract

Adobe PDF document0.82 Mb / in romanian

Thesis

CZU 616.233-007.272-036.12:616.131-008

Adobe PDF document 4.92 Mb / in romanian
218 pages


Keywords

COPD, pulmonary hypertension, endothelial dysfunction, pulmonary function, pathogenesis, diagnosis, clinical features, treatment, valsartan, nebivolol, sildenafil, vasaprostan, ACE inhibitors

Summary

The thesis consists of an introduction, 5 chapters, conclusions and recommendations, bibliography of 260 titles, 2 annexes, total volume of 218 pages of basic text, 60 tables and 6 figures. The obtained results are published in 160 scientific works and 1 monography. Field of study: 321.07 - phthysiopneumology.

Purpose of the thesis: To study pulmonary hypertension pathogenetic characteristics, elaborate early diagnostic criteria and to optimize treatment of pulmonary hypertension in patients with chronic obstructive pulmonary disease and mixed cardio-pulmonary pathology.

Objectives: Estimation of central and pulmonary hemodynamics, gases metabolism and pulmonary ventilation parameters in patients with COPD; evaluation of central and pulmonary hemodynamics, gases metabolism and pulmonary ventilation parameters in patients with coronary heart disease, in patients COLD and mixed cardio-pulmonary pathology; study of endothelial dysfunction in patients with COLD; effectiveness of valsartan, nebivolol, ACE inhibitors, sildenafil and vasaprostan in correction of pulmonary hypertension, endothelial dysfuction, pulmonary ventillation disturbances, pulmonary diffusion capacity in COPD and mixed pathology, in patients with idiopatic pulmonary hypertension; optimizing of pulmonary hypertension pathogenetic treatment in patients with COPD and mixed cardio-pulmononary pathology.

Scientific novelty and originality: For the first time in Republic of Moldova were obtained data, that characterized frequency, structure, forming particularities, clinical manifestations of pulmonary hypertension in patients with chronic obstructive pulmonary disease. Also for the first time were estimated connection between the grade of pulmonary hypertension and hypoxemia severity, endothelial dysfuction, pulmonary ventillation disturbances, pulmonary diffusion capacity and COPD stages. There were evaluated efficacy of treatment with valsartan, nebivolol, sildenafil, vasaprostan and ACE inhibitors (enalapril, fosinopril, moexipril) on endothelial functional status, systemic arterial pressure and estimated possibility of their using in prevention and treatment of secondary pulmonary hypertention in patients chronic obstructive pulmonary disease.

Scientific problem solved: Early diagnostic and pathogenetic treatment of secondary pulmonary hypertension in patients with chronic obstructive pulmonary disease and mixed cardio-pulmonary pathology leads to reduction of severe cardio-vascular complications such as congestive heart failure and sudden death, considerable improves patients survival. Value of the work: According to obtained results, taking in account individual pharmacological response, there were elaborated methods of efficacy prognosis in prevention and treatment of secondary pulmonary hypertension in patients with COPD and mixed cardiopulmonary pathology.

Implementation of scientific results: Obtained results were implemented in three clinical departments of Research Institute of Phthysiopneumology „Chiril Draganiuc”; two departments of functional diagnostic (including Department of Ecocardiography and Doppler ultrasound with high resolution) of Republic Diagnostic Centre, Republic of Moldova.