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Study Objective: To compare the quantitative aspects of shortness of breath in patients with fibrous interstitial lung disease (ILD) associated with cardio ischemia; to compare analysis results of the data obtained during functional and instrumental examinations. Study Design: Open comparative study in parallel groups. Materials and Methods. The study included 47 patients with fibrous ILD: 8 patients had idiopathic pulmonary fibrosis; 25 patients had chronic hypersensitive pneumonitis, and 14 patients had fibrous non-specific interstitial pneumonia. The patients were divided into two groups: study group of 24 patients with fibrous ILD associated with cardio ischemia, and 23 controls with fibrous ILD without cardio ischemia. We analysed clinical symptoms, instrumental examination results, changes in patients’ functional status with and without cardiac pathology. Study Results. In patients with fibrous ILD and cardio ischemia, respiratory symptoms were more intensive than in patients without cardio ischemia. Patients with fibrous ILD and cardio ischemia experienced worsening of their shortness of breath statistically earlier (in 3.15 days) vs patients with isolated fibrous ILD, who had shortness of breath in 7.29 days (p < 0.05). Patients with fibrous ILD and cardio ischemia demonstrated mixed functional changes: restrictive (reduced lung capacity and FVRC) and obstructive disorders (reduced FEV1 and instantaneous exhalation rate, МСВ25); statistically significant reduction in diffusing lung capacity, p < 0.05. A shorter 6-minute walking distance, more marked desaturation (SрO2 reduction by 8.31% in the study group and by 2.12% in controls, p < 0.05), higher scores of Borg Dyspnoea Scale and CRP scale (Clinical, Radiographic, and Physiologic scoring system) demonstrated statistically reduced tolerance to physical exercises in patients with cardio ischemia. CT scans did not reveal any differences in the intensity of interstitial changes in patients of both groups; “ground glass” areas were significantly more intense in patients with cardio ischemia, p < 0.05. Pulmonary hypertension and structural changes in right compartments of heart were recorded in patients in both groups; however, left ventricular hypertrophy and dysfunction were noted only in patients with cardio ischemia. Conclusion. In patients with fibrous ILD associated with cardio ischemia, intensification of shortness of breath can be a sign of a progressive respiratory disease or a new event: coronary event, atrial fibrillation attack, cardiac failure, chronic cor pulmonale. Assessment of the functional status using Borg Dyspnoea Scale, CRP, Medical Research Council Scale is a tool to identify the reasons of dyspnoea in primary care settings, to develop an algorithm for instrumental differential diagnosis of shortness of breath. Keywords: progressive fibrous interstitial lung diseases, quantification of shortness of breath, cardio ischemia.

Aim. The aim of the research was to study clinical, radiological, and functional parameters in patients with lung and intrathoracic lymph node sarcoidosis in combination with coronary heart disease. The nature of lung sarcoidosis clinical, radiological and functional manifestations in the presence of comorbid heart disease was analyzed. Material and methods. The study involved patients with lung and intrathoracic lymph node sarcoidosis divided into two groups. The fi rst main group consisted of patients with lung sarcoidosis and coronary heart disease as a concomitant pathology. The second comparison group was represented by patients with lung sarcoidosis without coronary heart disease. The diagnosis of pulmonary sarcoidosis was made based on clinical indicators, and the results of radiological studies (chest X-ray, chest computed tomography). Some patients had a morphological verifi cation of the diagnosis. The presence of coronary heart disease was confi rmed by typical clinical signs, electrocardiographic and echocardiographic changes. 6-minute walk test, spirometry, body plethysmography, and lung diffusion capacity evaluation was performed to assess the functional status. Results and discussion. Respiratory symptoms were more pronounced and they developed in a shorter time in patients with coronary heart disease. Physical exercise tolerance in this group was signifi cantly lower than in the main group. Spirometry and body plethysmography indicators did not differ between the groups. Lung diffusivity was signifi cantly lower in the group with coronary heart disease. This may be due to development of interstitial edema and microcirculatory disorders at alveolar-capillary membrane level. Moderate pulmonary hypertension was detected in both groups, with no signifi cant difference between them. Conclusion. The presence of coronary heart disease in patients with lung sarcoidosis worsens and accelerates respiratory symptom development. It leads to exercise tolerance signifi cant reduction and causes more pronounced diffusion disorders.

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Процесс диагностики саркоидоза легких и внутригрудных лимфатических узлов (ВГЛУ), сочетанного с ишемической болезнью сердца (ИБС) остается несовершенным. Более трети больных вместо рационального и активного дообследования получают длительные курсы противотуберкулезной и кортикостероидной терапии. Частота диагностических ошибок сохраняется на высоком уровне - 50-70%. Цель исследования: установление причин ошибок и особенностей диагностики саркоидоза у больных с наличием ИБС. Материалы и методы: исследование выполнено на базе пульмонологического отдела ФГБНУ «ЦНИИТ». Проведен анализ результатов обследования 49 больных саркоидозом легких и ВГЛУ без ИБС и 38 больных саркоидозом легких и ВГЛУ с ИБС. Результаты и обсуждение. При наличии ИБС ошибки диагностики саркоидоза регистрируются в 1,35 раза чаще, чем при ее отсутствии. Они связаны с неправильной трактовкой симптомов (у 13,5% больных), результатов функционального (18,41%) и рентгенологического (28,93%) исследований. Основная причина ошибок - недостаточное применение современных методов диагностики, включая компьютерную томографию (КТ) органов грудной клетки (ОГК) и бронхологическое исследование, отсутствие своевременной морфологической верификации диагноза. Заключение. У 60,49% больных ИБС отмечены трудности диагностики саркоидоза легких и ВГЛУ. Ошибки первичной диагностики саркоидоза связаны с малосимптомным течением заболевания в начальных стадиях, несоответствием клинических проявлений степени выраженности изменений в легких, скудностью функциональных нарушений. Наибольшие трудности отмечены при проведении дифференциальной диагностики с туберкулезом легких - 12,24%, со злокачественными новообразованиями - 8,16%, внебольничной пневмонией - 5,26%. Своевременное использование современных методов диагностики (КТ ОГК, морфологическая верификация диагноза) сокращает число ошибок в 1,34 раза.