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Effectiveness of pharmacological correction of renin-angiotensin-aldosterone system activity in chronic pulmonary heart


Author: Natalia Corneiciuc
Degree:doctor of medicine
Speciality: 14.00.05 - Internal Diseases (with specification: Pulmonology, Gastroenterology, Hepatology, Nephrology, Functional Diagnostics and Endoscopy)
Year:2006
Scientific adviser: Ion Butorov
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 27 September, 2006
Approved by NCAA on the 21 December, 2006

Abstract

Adobe PDF document0.27 Mb / in romanian
Adobe PDF document0.28 Mb / in russian

Thesis

CZU 616.24:616.12+615.71

Adobe PDF document 0.89 Mb / in russian
126 pages


Keywords

chronic obstructive pulmonary diseases, chronic pulmonary heart, renin-angiotensin-aldosterone system, systolic and diastolic function of right and left ventricle, renin, aldosterone, lisinopril, spironolacton

Summary

The results of the complex examination of 126 patients with chronic obstruction pulmonary diseases (COPD), complicated with chronic pulmonary heart (CPH) showed up the activation of renin-angiotensin-aldosterone system (rising of renin and angiotensin converting enzyme (ACE) activity, aldosterone plasmatic concentration). The rising of renin activity and aldosterone concentration have correlation with the level of pulmonary hypertension, hypoxemia, structural and functional changes of right and left ventricle (LV). The process of heart remodeling is characterized by increasing of anterior wall thickness and dimensions of right ventricle (RV) and right auricle (RA), signs of diastolic dysfunction of type of impaired relaxation or pseudonormal type and systolic dysfunction of RV. The state of LV is characterized by diastolic dysfunction of type I, which is accompanied with moderate systolic dysfunction of LV and depression of LV ejection fraction in decompensated CPH. The administration of inhibitor of ACE lisinopril in compensated CPH leads to depression of average pressure in the pulmonary artery, improvement of RV and LV diastolic function, and also we see tendency to decreasing the thickness anterior wall of RV, systolic and diastolic dimensions of both ventricles, dimensions of RA. This ceases the progressing diastolic and systolic dysfunction of right and left heart chambers and appearance of heart failure clinical signs. The combined used (usage) of lisinopril and spironolactone in patients with decompensated CPH leads to significant improvement of diastolic function of RV and LV, to the decreasing systolic and diastolic dimensions of both ventricles and auricles at the end of the first year, which becomes more considerable and accompanies by the improvement of their systolic function and depression of pulmonary hypertension, which ceases progressing chronic heart failure, ameliorates clinical patients status and prognosis for a disease.