Aim. Study of the nature and characteristics of changes in the coronary bed in patients with acute coronary syndrome (ACS) and chronic obstructive pulmonary disease (COPD).Materials and methods. The study included 85 patients with ACS: group 1 included 47 patients with ACS and COPD, group 2 included 38 patients with ACS. All patients underwent a comprehensive clinical, instrumental and laboratory examination.Results. In the majority of patients of group 1 (76.6%), two- and three-vessel lesions of the coronary bed were revealed, and arterial stenoses were multiple, located mainly in the middle and distal parts of the arteries. In (76.3%) patients of the 2nd group, one- and two-vessel lesions of the coronary bed with localization of stenoses mainly in the proximal and middle segment of the coronary arteries (CA) were revealed. The total number of stenosis and hemodynamically significant stenosis was higher in group 1 compared to group 2 (p=0.01). Extended stenoses were more common in group 1 patients (p=0.04). Damage to the CA of the 2nd order was also higher in the 1st group of patients (p=0.01). The 1st group was divided into two subgroups: 1A (26 people) − patients with COPD of moderate severity and 1B (21 people) − patients with severe COPD. In patients of subgroup 1B, a more significant lesion of the coronary bed was noted due to an increase in the total number of stenoses (p=0.02), hemodynamically significant stenoses (p=0.01), localized in the proximal (p=0.04) and distal (p=0.02) segments of the coronary artery, in the branches of the 2nd order (p=0.02), as well as occlusions and critical stenoses of the coronary artery (p=0.02).Conclusion. The severity of COPD in patients with ACS significantly affects the number of hemodynamically significant proximal and distal stenoses, as well as branches of the second order coronary arteries, which reduces the effectiveness of surgical treatment and worsens the prognosis of patients with comorbidities.

Федерации, 197022, г. Санкт-Петербург, ул. Льва Толстого, 6- University, 6-8 Lʹva Tolstogo Str., Saint Petersburg, 197022, Russian Federation The aim of the study was to examine the influence of telmisartan on the condition of the diaphragm in patients with chronic obstructive pulmonary disease (COPD) at the stage of compensated chronic pulmonary heart (CPH). We examined 30 patients with COPD, complicated with CPH, who had the examination of pulmonary and intracardiac hemodynamics and the functional state of the diaphragm by means of ultrasound scanning. It was found that that the inclusion of telmisartan in the complex therapy of COPD patients with compensated CPH contributes to the normalization of systolic pressure in the pulmonary artery, the functional ability of the right ventricle, and values of the respiratory function. The application of telmisartan in a daily dose of 4 mg during 4 weeks while treating the patients with COPD complicated with compensated CPH leads to the improvement of the functional state of diaphragm, normalization of diaphragm excursion under forced respiration and contractility of diaphragm muscle, which gives an opportunity to increase the efficiency of treatment of these patients.Key words: chronic obstructive pulmonary disease, chronic pulmonary heart, ultrasound scanning, dysfunction of the diaphragm, telmisartan.Хроническая обструктивная болезнь легких (ХОБЛ) в настоящее время является глобальной про-блемой [1,4]. Распространенность ХОБЛ увеличива-ется с возрастом, практически у каждого второго мужчины в возрасте старше 70 лет, проживающего в сельской местности, диагностируется ХОБЛ. Ежегодно от ХОБЛ умирает 2,75 млн человек, что составляет 4,8% всех причин смерти.Предикторами летальности больных ХОБЛ служат такие факторы, как тяжесть бронхиальной обструкции, выраженность одышки, легочная гипертензия.Известно, что существенную роль в развитии дыха-тельной и легочно-сердечной недостаточности у боль-ных ХОБЛ играет прогрессирующая слабость дыхательной мускулатуры, возникающая вследствие повышения нагрузки на респираторные мышцы [1,3, 6].Современные представления о важной роли дис-функции дыхательных мышц в развитии и прогресси-ровании легочно-сердечной недостаточности диктуют необходимость разработки высокоинформативных ме-тодов диагностики и лечения нарушений функциональ-ной способности диафрагмы у больных ХОБЛ [2,4,5].В связи с высокой распространенностью ХОБЛ проблема лечения остается весьма актуальной. В лече-нии больных ХОБЛ с хронической сердечной недоста-

The aim of the study was to study the correlation between the indices of the functional state of the diaphragm and pulmonary hemodynamics in COPD patients at different stages of chronic pulmonary heart (CPH). 79 patients with COPD were examined. Patients were divided into 2 groups, taking into account the pulmonary artery pressure and the presence of clinical signs of right ventricular failure. The first group included 40 COPD patients complicated by compensated CPH; the second group included 39 patients with decompensated CPH. A complex examination of intracardiac hemodynamics and functional state of the diaphragm was carried out at the XD-11 XE device PHILIPS (USA). The following results were obtained: in patients with compensated CPH there was an increase in the thickness of the diaphragm, a decrease in the diaphragm mobility during tidal and forced breathing, and an increase in the rate of contraction of the diaphragm during tidal and forced breathing. Patients with decompensated CPH were found to have an increase in the thickness of the diaphragm, a sharp decrease in the diaphragm excursion during tidal and forced breathing, a decrease in the fraction of thickening of the muscular part of the diaphragm. The correlation analysis revealed the most informative ultrasound indices of the impairment of the functional state of the diaphragm in patients with COPD, significantly associated with pulmonary hemodynamic indices: diaphragm excursion during tidal and forced breathing, relaxation rate of the diaphragm muscle, thickness and fraction of thickening of the muscular part of the diaphragm. Determination of the functional state of the diaphragm in patients with COPD allows an early detection of signs of respiratory muscle dysfunction, a timely appointment of corrective therapy, and prevention of the development and progression of pulmonary-cardiac failure.

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