The risk factors of cardiovascular disorders in children with chronic bronchopulmonary diseases
DOI:
https://doi.org/10.14739/2310-1210.2018.02.125170Keywords:
pulmonary disease, cystic fibrosis, asthma, child, cardiovascular systemAbstract
The purpose was to determine the features of cardiovascular system morphofunctional state and the risk factors for cardiovascular disorders formation in children with chronic bronchopulmonary diseases.
Materials and methods. We examined 144 patients aged 3–16 years (mean age was 11.3 ± 1.2 years) with chronic bronchopulmonary pathology (60 patients with cystic fibrosis with pancreatic insufficiency and 84 patients with heavily treated or partially treated persistent bronchial asthma) and 68 conditionally healthy children who made up the control group. A complex of functional methods for cardiovascular system studying in patients with chronic bronchopulmonary diseases included: echodopplercardiography with determination of left ventricular myocardium geometry, Holter monitoring of cardiac activity, duplex scanning of the common carotid artery by intima-media thickness measuring of the common carotid artery wall and examining the index of endothelial stress shift. To determine the risk factors for cardiovascular disorders development in children with chronic bronchopulmonary diseases, a method E. N. Shigan was used to normalize intensive indicators, based on the Bayesian probabilistic method. A prognostic model of cardiovascular disorders development was obtained using the exponential regression equation for patients with chronic bronchopulmonary diseases.
Results. According to results of the study it has been found that there is a structural and functional restructuring of the left ventricular myocardium on the background of the cardiac activity vegetative regulation violation and vascular remodeling in children with chronic bronchopulmonary diseases. The definition of risk factors for cardiovascular complications development in children with bronchial asthma has showed the followings: the presence of chronic infection (OR = 8.4), the age of child from 3 to 6 years (OR = 4.9), the disease duration more than 3 years (OR = 2.3), the circadian index value less than 1,2 units (OR = 3.1) and QTc interval prolongation more than 420 ms (OR = 2.1). The main risk factors for cardiovascular disorders formation in the group of children with cystic fibrosis were the age of the child from 3 to 6 years (OR = 4.0), contamination of the respiratory tract by Pseudomonas aeruginosa (OR = 4.0), severe course of the disease (OR = 3.3), the presence of chronic infection (OR = 6.0), the body mass index less than P50 (OR = 4.2) and the QTc interval duration more than 420 ms (OR = 1.4). The risk of cardiovascular complications was increased with the presence of 3 or more risk factors that confirmed by the equation of exponential regression in the group of patients with chronic bronchopulmonary diseases.
Conclusions. The development of cardiovascular complications is caused by a combination of many factors in children with chronic bronchopulmonary diseases. It is necessary to include into the algorithm for examination heart echodopplerography, Holter heart rate monitoring, duplex scanning of the common carotid artery with determination of the endothelial stress index shift and intima-media thickness at least twice a year for the purpose of cardiovascular disorders early diagnosis in children with chronic bronchopulmonary diseases, having 3 or more risk factors for cardiovascular complications. Timely detection of a risk group for cardiovascular disorders development will allow the full implementation of preventive measures and medications for cardiovascular disorders correcting in children with chronic bronchopulmonary diseases.
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