Nghiên cứu biểu hiện lâm sàng, điện tim, siêu âm tim và kết quả chụp cắt lớp vi tính đa dãy động mạch vành ở bệnh nhân bệnh phổi tắc nghẽn mạn tính tt tiếng anh

1

EXECUTIVE SUMMARY
Chronic obstructive pulmonary disease is the fourth leading
cause of death in the world after heart disease, cancer and brain stroke.
Although chronic obstructive pulmonary disease predominantly affects
the lungs, it also causes or is associated with many systemic conditions,
especially cardiovascular disease. The effects of cardiovascular disease
caused by chronic obstructive pulmonary disease and the combination of
cardiovascular disease with chronic obstructive pulmonary disease
further increase the severity of the disease, increase complications,
increase mortality ratios; and coronary artery disease is the leading cause
of death from cardiovascular disease. The introduction of coronary
computer tomography (Computer Tomography-CT) is considered as a
solution for the diagnosis of coronary artery lesions.
There are a number of studies on chronic obstructive pulmonary
disease in Vietnam, covering many aspects of the disease in patients with
chronic obstructive pulmonary disease but no specific and detailed
research is available. Coronary lesion points in patients with chronic
obstructive pulmonary disease. Therefore, continuing to study the
characteristics of cardiovascular disease in patients with chronic
obstructive pulmonary disease, especially the study of coronary artery
damage on computerized tomography in high-risk groups and is related
to some clinical features of chronic obstructive pulmonary disease which
is necessary, with scientific and practical significance necessary to
improve the understanding of the relationship between them contributing
to the prognosis, improving the effectiveness of the treatment. treatment
and mortality reduction. We conduct research on the subject: "The study


2

of clinical manifestations, ECG, echocardiography and results of
coronary artery computed tomography in patients with chronic
obstructive pulmonary disease".
1. The objective of the topic:
1.1. Describe clinical features, ECG, echocardiography of some
cardiovascular diseases in patients with chronic obstructive
pulmonary disease.
1.2. Evaluation of the results of computerized tomography of coronary
artery multilayer in patients with chronic obstructive pulmonary
disease with high cardiovascular risk and related with some clinical,
subclinical characteristics of obstructive pulmonary disease chronic.
2. New contributions of the thesis
- Describes the clinical features, ECG, echocardiogram of some
cardiovascular diseases in patients with chronic obstructive pulmonary
disease.
- Evaluates the results of computerized tomography of coronary artery
series and its relationship with clinical and subclinical patients with
chronic obstructive pulmonary disease.
3. The thesis structure
The thesis consists of 126 pages, with 4 chapters: Introduction 02
pages, Chapter 1- Overview: 37 pages, Chapter 2- Objects and research
methods: 24 pages, Chapter 3- Results: 34 pages, Chapter 4 Discussion: 28 pages. Conclusions and recommendations: 03 pages.
The thesis has 36 tables, 15 pictures, 05 charts, 05 graphs, 03
diagrams, 131 references: 51 Vietnamese, 1 French and 79 English.


3

Chapter 1

OVERVIEW
1.1. CHRONIC OBSTRUCTIVE PULMONARY DISEASE
According to BOLD (The Burden of Obstructive Lung Disease)
and other major epidemiological studies, there were an estimated 385
million cases of chronic obstructive pulmonary disease in 2010, with the
prevalence in the world is 11.7%. Globally, there are about 3 million
deaths annually. With the increase in smoking rates in developing
countries and the aging population in high-income countries, the
incidence of chronic obstructive pulmonary disease is expected to
increase over the next 30 years and until next year. 2030 there could be
up to 4.5 million deaths annually from chronic obstructive pulmonary
disease and related conditions.
Classification of severity of chronic obstructive pulmonary
disease based on FEV1 after bronchodilator remedy (GOLD
2016)
In patients with FEV1 / FVC index <0.7
The level of RLTK congestion

FEV1 values after bronchodilator rehab

GOLD 1: minor

FEV1 ≥ 80% of the theoretical value

GOLD 2 : medium

50% ≤ FEV1< 80% theoretical value

GOLD 1: serious

30% ≤ FEV1< 50% theoretical value

GOLD 1: very serious

FEV1< 30% theoretical value

1.2. SOME OF THE DISEASES OR MEETED IN CHRONIC
DISEASES WITH CHRONIC DISEASES


4

Cardiovascular manifestations in patients with chronic obstructive
pulmonary disease are plentiful and the expression chain has been
recognized for several decades. Chronic obstructive pulmonary
disease increases the risk of cardiovascular disease by 3 times higher
than healthy people and about 50% of all causes of death in patients
with obstructive pulmonary disease. chronic. Increased incidence of
pulmonary artery pressure, right heart failure and effects on the left
heart, hypertension, arrhythmia, ischemic heart disease in patients
with chronic obstructive pulmonary disease are higher than patients
without the disease. Chronic obstructive pulmonary. The prevalence
of chronic obstructive pulmonary disease in heart failure patients
varies from 11% to 52% in the US and from 9% to 41% in Europe,
while the incidence of heart disease in patients with obstructive
pulmonary disease Chronic obstruction varies from 14% to 33%.
1.3. THE ROLE OF CUTTING WITH MULTI-COMPUTING
CLASSES IN THE ASSESSMENT OF VERTICAL CIRCUIT
MOVEMENTS
Selective coronary angiography is considered the reference

gold standard for coronary non-invasive exploration. With high
resolution, selective coronary angiography gives accurate coronary
lesion results. However, selective coronary angiography is a method
of probing for bleeding, with certain complications. Imaging studies
such as cardiac tomography and cardiac magnetic resonance imaging
are the method of choice for detecting coronary artery abnormalities.
Cardiac angiography has shown greater accuracy than invasive
angiography and fully identifies anatomical detail with high temporal
and spatial resolution. The coronary microcomputer tomography
tomography has achieved a high temporal and spatial coronary
image, a collimated probe and a thinner slice thickness increase the
shutter speed thus reducing shooting time in a meaningful way. It is
hoped that in the future, coronary angiography may completely


5

replace selective coronary angiography in low and moderate risk
cases.
Chapter 2
THE SUBJECTS AND METHODS OF THE STUDY
2.1. Research subjects
Among 256 patients diagnosed with chronic obstructive
pulmonary disease, we selected 162 patients with chronic obstructive
pulmonary disease with cardiovascular conditions eligible for
research and treatment at the Department of Internal Respiratory,
Cardiovascular Internal Medicine and Emergency Internal Medicine
Department - St. Paul General Hospital. The study period is from
01/2016 to 10/2018.
2.1.1. Criteria for selecting patients to study

- Patients diagnosed with chronic obstructive pulmonary
disease according to GOLD 2016.
- Patients with chronic obstructive pulmonary disease with
common cardiovascular disease: the patient is diagnosed with
hypertension according to JNC 7, heart failure according to the
European Heart Association 2012, the diagnosis identifies anemia.
local, arrhythmia.
- Patients with chronic obstructive pulmonary disease
underwent CT scans of the coronary artery system based on the
guidelines of the American College of Cardiology (ACC / AHA
2006).
- The patient agrees to participate in the study.
2.1.2. Exclusion criteria


6

The patient could not measure pulmonary ventilation,
perform electrocardiography, echocardiography, and did not take
multi-computed tomography. The patient did not agree to cooperate.
The patient was re-hospitalized during the study.
2.2. Content and research methods
2.2.1. Research content
- Describe clinical features, ECG, echocardiography of some
cardiovascular diseases in patients with chronic obstructive
pulmonary disease.
- Evaluation of the results of computerized tomography of
coronary artery series in patients with chronic obstructive pulmonary
disease with high cardiovascular risk and the relationship with some
clinical, subclinical characteristics of chronic obstructive pulmonary

disease. count.
2.2.2. Research Methods
Cross-sectional
convenient.

descriptive

study.

Sampling

method:

2.2.2.1. Clinical research
- Information collection: Age, gender, smoking history and
duration of illness.
- Systemic symptoms: fever, purple lips, edema
- Functional symptoms: cough, sputum, difficulty breathing.
- Physical symptoms: muscle spasms, heart rate, wheezing,
snoring, hepatomegaly ...
2.2.2.2. Subclinical research


7

The patient was tested strictly for blood (blood and blood
biochemistry, blood gas), standard pulmonary X-ray, pulmonary
ventilation, ECG, echocardiography and dynamic multi-array
computer tomography coronary artery.
2.3. Data collection and processing:

- All patients in the research group were allowed to conduct
clinical examination, history and medical history according to their
own medical records and necessary tests upon admission.
- The research data is encrypted and processed based on
SPSS 16.0 medical statistics software.

Chapter 3
RESEARCH RESULTS
3.1. Clinical characteristics, ECG, echocardiography and some
cardiovascular diseases in patients with chronic obstructive
pulmonary disease
3.1.1. Clinical characteristics

Table 3.1. Distribution by age and gender
Age group
(n)
<50

General

Male

Female

n=162

Ratio
%

n=121

Ratio
%

n=41

Ratio
%

1

0,6

1

0,8

0

0,0

P


8

50-59

16

9,9

13

10,7

3

7,3

60-69

49

30,2

39

24,1

10

6,2

70-79

54

33,3

38

23,5

16

9,9

≥80

42

25,9

30

18,5

12

7,4

The average
age

72,3 ± 9,8

71,7 ± 9,9

>0,0

5

74,3 ± 9,2

The study results showed that the average age of patients in
the study was 72.3 ± 9.8. The proportion of males (7 4.7%) met more
than females (25.3%). The male to female ratio is 3/1.
Table 3.5. Physical symptoms
Physical symptoms
Chest shape barrel
Traction of respiratory muscles
Cyanosis lips - extremities
Edema leg
Natural floating neck veins
Hepatomegaly
Hepatic venous feedback (+)
Fast pulse (> 90times / minute)
Breathing> 20 times / minute
Increase of blood pressure
Systolic blowing 3-valve valve
T2 strong, split valve pulmonary artery
Hartzer sign (+)
Hissing, snoring
Exploding, moist
Listen to the lungs
Alveolar reduction

n = 162
89
155

107
34
63
56
56
118
158
136
23
27
23
117

Ratio (%)
54,9
95,7
66,0
21,0
38,9
34,6
34,6
72,8
97,5
84,0
14,2
16,7
14,2
72,2

79

48,8

82

50,6


9

The results in Table 3.5 show that up to 97.5% of patients
have tachypnea and 95.7% of patients have respiratory muscle
spasms. These are the 2 most common physical symptoms. The next
is hypertension (84.0%), fast accounted for 72.8%, barrel-shaped
signs accounted for 54.9%. The percentage of patients who heard
lung with wheezing or snoring accounted for the highest rate
(72.2%), followed by alveolar murmur reduction (50.6%) and moist,
explosive rashes (48.8%). The percentage of patients with
spontaneous neck veins was naturally similar, responses to neck veins
(+) and hepatomegaly were similar (38.9%; 34.6%).
3.1.2. Subclinical characteristics
3.1.2.1. ECG results

Table 3.10 ECG results

ECG manifestations

Results
n=162

Ratio (%)

Right atrial thickening

23

14,2

Right ventricular thickening

36

22,2

Right atrial thickening + right ventricular thickening

11

6,8

Left atrial thickening

21

13,0

Left ventricular thickening

16

9.9


10

Arrhythmia

Atrial systolic

2

1,2

Ventricular ectopic

3

1,9

Supraventricular tachycardia

3

1,9

Atrial fibrillation

11

6,8

86

53,1

Right bundle branch block

49

30,2

Left bundle branch block

3

1,9

Ischemic heart disease
Conductive disorders

Block A-V level I
2
The proportion of patients with right atrial thickness is 14.2%
and right ventricular thickness is 22,2%; left atrial thickness on the
electrocardiogram is 13% and left ventricular thickening accounts for
9.9%; Atrial fibrillation accounts for 6.8%; Ischemic heart disease
accounted for 53.1%; right bundle branch block is 30.2% and left
bundle branch block is 1.9%.
3.1.2.2. Echocardiography results
Table 3.11. Results of some echocardiography indicators

Echocardiography index

n=162

Ratio (%)
± SD

Right ventricular
diameter (mm)
Dd (mm)

EF (%)

Increase
No increase
Increase
No Increase
Decrease
(<50%)
No decrease

58
104
15
147

35,8
64,2
9,3

90,7

21

13,0

141

87,0

22,1 ± 4
43,5 ± 6,9

67,4 ± 11,8

1,2


11

The results of Table 3.11 show that the proportion of patients
with chronic obstructive pulmonary disease with right ventricular
diameter increased by 35.8%. The mean value of right ventricular
diameter is 22.1 ± 4 mm. The percentage of patients with Dd
increases by 9.3%, the average value of Dd is 43.5 ± 6.9 mm. with
EF reduced by 13%, the average value of EF is 67.4 ± 11.8
3.1.3. The incidence of cardiovascular disease in patients with
chronic obstructive pulmonary disease

Table 3.15. The incidence of cardiovascular disease in patients with

chronic obstructive pulmonary disease
Types of cardiovascular pathologies

n=162

Ratio%

Arrhythmia

73

45,1

Hypertension

136

84,0

Ischemic heart disease

86

53,1

Heart failure

82
50,6
Patients with chronic obstructive pulmonary disease had

arrhythmia accounting for 45.1%, hypertension accounted for 84%,
with ischemic heart disease was 53,1%, heart failure accounted for
50, 6%.
3.2. Characteristics of computerized tomography of multicoronary artery computer scan
3.2.1. Number of coronary artery lesions

Figure 3.3. Patient distribution according to number of damaged
coronary arteries


12

The results in Figure 3.3 show that only 1 patient had normal
coronary artery (1.8%). There were 29 patients with one coronary
artery stenosis (51.8%). The percentage of patients with coronary
artery stenosis was 28.6% (16 patients) and stenosis of all 3 branches
accounted for 17.9% (10 patients).
3.2.2. Distribution of location and severity of coronary artery
damage

Figure 3.4. Distributed lesion branch location
The proportion of patients with chronic obstructive
pulmonary disease with coronary artery stenosis was 60.7%, of
which LAD stenosis was 35.7%, followed by RCA (30.4%), LCX
stenosis was 10.7%. . Only 1.8% of patients have LM.
Table 3.27. The degree of stenosis of the coronary arteries

Circuit
section
LM

LADI
LADII
LADIII
LCXI
LCXII
LCXIII
RCAI
RCAII
RCAIII

Nonstenosis
n
Ratio
(%)
48
85,7
26
46,4
27
48,2
49
87,5
42
75,0
38
67,9
53
94,6
37
66,1

29
51,8
48
85,7

Stenosis < 50%

Stenosis 50-70%

Stenosis ≥ 70%

n

n

n

7
16
13
2
9
12
2
9
13
2

Ratio
(%)

12,5
28,6
23,2
3,6
16,1
21,4
3,6
16,1
23,2
3,6

0
8
9
1
3
4
0
3
4
0

Ratio
(%)
0
14,8
16,1
1,8
5,4
7,1

0
5,4
7,1
0

1
6
7
4
2
2
1
7
10
6

Ratio
(%)
1,8
10,7
12,5
7,1
3,6
3,6
1,8
12,5
17,9
10,7

13

Stenosis> 50% of coronary arteries is most common in LAD
II (16.1%), followed by LAD I (14.8%), followed by RCA II, LCX II
with 7.1% % and RCA I, LCX I together accounted for 5.4%. No
coronary artery stenosis was found in LM, LCX III and RCA III.
The degree of stenosis ≥ 70% of coronary artery is most
common in RCA II (17.9%), followed by LAD II, RCA I together
accounting for 12.5% and LAD I (10.7%). The lowest rate is LM
(1.8%).
Table 3.30. Relationship between damaged coronary artery location
and stage of disease
Location of
coronary artery
lesions
LM

Stage II
n=31
Ratio (%)
1
3,2

Stage of disease (n = 56)
Stage III
n=16
Ratio (%)
0
0

n=9
0

RCA

11

35,5

7

43,8

3

LAD

13

41,9

5

31,3

4

LCX

6

19,4

4

25

2

The results of Table 3.30 show that the number of patients
with coronary artery stenosis stage II is 31/56 patients (55.4%), phase
III is 16/56 patients (28.6%) and stage IV 9/56 patients (16.1%).
Stage II of the disease, lesions of LAD arm were the most common
(41.9%), followed by RCA arm (35.5%), at least LM arm (3.2%). In
Stage III, RCA lesions were the most common (43.8%), followed by
LAD (31.3%), LCX had the lowest rate (25%), no patients had
lesions. at LM. Stage IV is the most vulnerable in LAD (44.5%),


14

followed by RCA (33.3%). Stage III and Stage IV no patients had
lesions in the LM arm.
Table 3.31. Relationship between damaged coronary artery location
and disease subgroup
Location of
coronary artery
lesions

n

%

n

LM
RCA
LAD
LCX

0
0
0
0

0
0
0
0

8
17
23
11

A

Disease subtypes (n = 56)
B
C

Tỷ lệ
n
Tỷ lệ
(%)
(%)
6
42,9
57,1
12
36,4
51,5
15
36,6
56,1
50,0
9
40,9

The results of Table 3.31 show that no patients with coronary
artery stenosis in group A. Group B and group C have coronary
stenosis in the branches. Group D does not have coronary artery
stenosis in the LM arm. And group B had the highest proportion of
coronary artery stenosis at branch sites, followed by group C, at least
in group D.

Table 3.34. Relationship between artery branch location and lesion
and lung X-ray image
X-ray image
n = 56

Emphysema
Bronchial wall

Location of coronary artery lesions
LM
RCA
LAD
LCX
n
Ratio n Ratio
n
Ratio
n
Ratio
(%)
(%)
(%)
(%)
1
1,8
17
30,4
20
35,7
6
10,7
1
1,8
17
30,4

20
35,7
6
10,7


15

thickening
Dirty lung image
Redistribution
of
blood vessels
Tear-dropped
heart
shape
Cardiac / thoracic
index> 50%

1
1

1,8
1,8

14
14

25
25

16
16

28,6
28,6

6
6

10,7
10,7

0

0

3

5,4

6

10,7

0

0

1

1,8

6

10,7

6

10,7

4

7,2

The results of Table 3.34 show that, among the lesions on the
X-ray image, patients with LAD had the highest incidence, followed
by RCA and LM with the lowest incidence.

Table 3.35. Relationship between damaged coronary branch
position and right ventricular diameter, Dd, EF on ultrasound
Echocardiography
index
n = 56

Right
ventricul
ar
diameter
(mm)

Dd (mm)

LM

Location of coronary artery lesions
RCA
LAD

LCX

n

Ratio
(%)

n

Ratio
(%)

n

Ratio
(%)

n

Ratio
(%)

Increase

25

44,6

10

17,9

7

12,5

23

41,1

No increase

31

55,4

44

78,6

32

57,1

7

12,5

Increase

9

16,1

18

32,1

4

7,2

9

16,1


16

EF(%)

No increase

46

82,1

21

37,5

32

57,1

41

73,2

Decrease
(<50%)

10

17,9

8

14,3

6

10,7

10

17,9

No decrease

44

78,6

31

55,4

30

53,6

40

71,4

The results of Table 3.35 show that right ventricular diameter
increased most in the LM segment (44.6%), followed by the LCX
arm (41.1%) and the least LAD arm (12.5% 0. Dd). The highest gain
was in the RCA segment (32.1%), followed by the LM and LCX arm
(16.1%) and the least LAD arm (7.2%) and the largest decrease was
in the LM and LCX segments (17.9%), followed by RCA (14.3%),

especially LAD (10.7%).

Table 3.36. Relationship between damaged coronary artery position
and systolic pulmonary systolic pressure on ultrasound
Systolic pulmonary
pressure
n = 56

LM
n

No decrese
Increase
(n=31)

Slightly
(> 30 - 40
mmHg)
Medium
(> 40 - 70
mmHg)

Location of coronary artery lesions
RCA
LAD
LCX
n

0

Tỷ lệ
(%)
0

n

0

Tỷ lệ
(%)
0

0
0

n

0

Tỷ lệ
(%)
0

0

Tỷ lệ
(%)
0

0

2

3,6

4

7,2

0

0

0

6

10,7

11

19,6

1

1,8


17

Significant
(> 70 mmHg)
The mean of pulmonary
pressure (mmHg) (
SD)

0

0

35,8±13,0

0

0

36,1±14,0

0

0

34,9±12,1

0

0

37,7±18,6

±

The results in Table 3.36 show that there is no coronary
injury in patients without pulmonary hypertension. Mild and
moderate pulmonary hypertension, most common lesions were LAD
arm (7.2% and 19.6%), followed by RCA arm (3.6% and 10.7%)
LCX branching is common in patients with the highest
average systolic pulmonary artery pressure (37.7 ± 18.6 mmHg),
RCA lesions are common in patients with systolic pulmonary artery
pressure with the mean of 36.1 ± 14.0
Chapter 4
DISCUSSION
4.1. Clinical and subclinical characteristics of research subjects
4.1.1. Clinical characteristics
Physical symptoms: our research results (Table 3.5) show
common symptoms: barrel-shaped chest (54.9%); spasms of the
respiratory tract (95.7%); snoring, snarling (72.2%). As commented
by many other authors such as Nguyen Chinh Dien, Nguyen Thi Kim
Oanh, the lips and head of the limb had 107/162 patients (66.0%),
this is a common symptom during exacerbation due to patients with
impairment. Respiratory. Breathing rate> 20 breaths / minute
accounted for the majority of 158/162 patients (97.5%) as
commented by Nguyen Thi Kim Oanh 92/100 patients (92%).


18

Increasing blood pressure we met 136/162 patients (84%), higher
than the general prevalence rate in the Vietnamese population
because the study subjects were chronic obstructive pulmonary

disease, the majority of smokers - risk factors for cardiovascular
disease and common age ≥ 60 years - is the age with a higher
incidence of hypertension.
4.1.2. Subclinical characteristics
Right atrial thickening, right ventricle thickening, right atrial
thickening + right ventricle has 75/162 patients (accounting for
46.3%). Our results are consistent with Nguyen Thi Thuy Nga
(35.8%) and Stolz D 76/167 patients (45.5%) and lower than the
research results of the authors Nguyen Chinh Dien 72 / 102 patients
(accounting for 70.6%). It can be explained that the authors did not
study in patients with arrhythmia, valvular heart disease,
cardiomyopathy, associated myocardial ischemia. The arrhythm we
encountered in 19/162 patients accounted for 11,7%, including
ventricular tachycardia in 3/162 patients (1.9%), atrial fibrillation in
11/162 patients (6.8%). According to Shih HT and CS when
investigating mobile cardiac arrhythmias in patients with chronic
obstructive pulmonary disease, 69% of supraventricular arrhythmias:
83% of ventricular ectopic ventricle, 22% of ventricular tachycardia.
Ischemia is often associated with chronic obstructive pulmonary
disease because it usually occurs in smokers. In our study, 86/162
patients (53.1%). This result is higher than the research of Nguyen
Thi Kim Oanh with this rate is 12%. Mapel D.W compared with
COPD group had 33.6% cases of ischemic heart disease higher than
group without COPD (27.1%).
4.1.3. The incidence of cardiovascular disease in patients with
chronic obstructive pulmonary disease


19

Our study in Table 3.15 found that, among cardiovascular
diseases, hypertension accounted for the highest proportion (84%),
followed by ischemic heart disease (57.4%), arrhythmia. heart rate
accounts for 45.1%, heart failure accounts for 50.6%.
The rate of hypertension in our study is higher than that of
the author Nguyen Thi Kim Oanh with 37/100 patients (37%)
because at present, the condition of atherosclerosis, overweight is a
common and increasing cause. increase. The rate of our arrhythmia is
lower with the review of author Nguyen Thi Kim Oanh with 76/100
patients (76%) This is because we did not choose patients with
chronic obstructive pulmonary disease with tachycardia. sinus.
Because patients may be hospitalized with fever, shortness of breath
and patients treated with salbutamol increase the heart rate but this
tachycardia is not due to cardiovascular disease. Our research is
higher than that of Nguyen Thi Kim Oanh (12%) because of ischemic
heart disease, which is common in patients with chronic obstructive
pulmonary disease, a consequence of coronary artery disease. Again,
due to atherosclerosis, chronic hypoxia in severe patients, the heart
failure rate in our study was 50.6%, similar to that of authors Ngo
Quy Chau and Nguyen Chinh Dien (40 , 1%) because of the same
cardiovascular disease study in patients with chronic obstructive
pulmonary disease but higher than the research result of Nguyen Thi
Kim Oanh (22%) because He studies the authors were not chronic
obstructive pulmonary disease. Right and total heart failure are an
indispensable consequence of chronic obstructive pulmonary disease
and are common in the advanced and very severe stages of the
disease.
4.2. Results of computerized tomography of multiple arteries in
patients with chronic obstructive pulmonary disease
4.2.1. Characteristics of patient distribution according to the

number of coronary artery lesions


20

Our research results show that (chart 3.3) only 1.8% of
patients have normal coronary arteries. The majority of patients had
narrow coronary artery stenosis (51.8%). The percentage of patients
with stenosis of the coronary artery is 28.6% and all 3 stenosis
accounts for 17.9%. This comment is not the same as Pham Viet Ha's
comment when studying coronary artery lesions in patients with
diabetes: the majority of patients have 2-branched lesions, of which
2-arm injuries account for 32.3% (21 / 65), 3-branched lesions
accounted for 21.5% (14/65). This is understandable because the
characteristics of coronary lesions in diabetes are widespread, mixed
lesions (including soft atherosclerosis, mixed atherosclerotic,
calcified atheroma).
4.2.2. Characteristics of patient distribution according to location
of coronary artery lesion
In our study, the proportion of patients with chronic
obstructive pulmonary disease was surveyed for CT scan with
general coronary artery stenosis accounted for 60.7%. LAD branches
are the most common, accounting for 35.7%, followed by RCA
(30.4%). The proportion of patients with LCX stenosis is 10.7%.
Only 1.8% of patients have LM (chart 3.4). This result is consistent
with Vu Kim Chi in the study of CT scan values 64 sequences
assessing coronary lesions: the most common is LAD 102/121
(84.2%), followed by RCA 57 / 121 (47.1%), LCX 55/121 (45.4%)
and LM accounted for the lowest rate of 10/121 (8.2%). However, the
higher incidence of branches compared to us may be due to the

smaller number of patients in our study (56 patients versus 121
patients).
4.2.3. The degree of stenosis of the coronary arteries on
multidisciplinary computed tomography
Our research results in Table 3.27 show:


21

* Left common coronary trunk (LM):
In our study, the general stenosis at different levels
on CT 384 sequence was 8/56 patients (14.3%), in which
there was 1 narrow case on 70% of vascular diameter,
accounting for 1 ,8%. Pham Viet Ha's study of diabetic
patients showed that the prevalence of LM was 30.8%, of
which 4.6% was narrow> 50% and 3.1% was narrow> 70%.
Perhaps the difference between our study and Pham Viet Ha
may be due to the smaller number of our patients and the
study of coronary artery damage on two different subjects:
chronic obstructive pulmonary disease and diabetes mellitus.
* Main branches of coronary artery:
In our study, the narrowest rate was 50%, the most
narrow in LAD II (16.1%) and LAD I (14.8%), then RCA II,
LCX II accounted for 7.1%. and RCA I, LCX I all accounted
for 5.4%. The vulnerability characteristics in our study are
generally consistent with the conclusions of Vu Kim Chi's
study (2013) with the narrowness of 50%, the most narrow
rate is LAD II (55.3%), LAD I (50.4%), RCA II (31.4%),
LCX II (30.5%) and Pham Viet Ha with the highest narrow
ratio were LAD I (18.5%) and then RCA II ( 10.8%), LCX II

(10.8%).
In our study, the narrowest rate was 70%, the most narrow in
RCA II (17.9%), followed by LAD II and RCA I, both were 12.5%,
followed by LAD I and RCA III. are all 10.7%. The lowest rates are
LM and LCX III (1.8%). This result is different from that of Pham
Viet Ha which was the most narrow LAD II (47.7%) and RCA I
(30.8%) then LAD I (26.2%), LCX II (15.4). Author Vu Kim Chi also
met the most in LAD II (55.3%), LDA I (50.4%), followed by RCA
II (31.4%), LCX II (30.5). Thus, the severe stenosis requiring


22

intervention occurs mainly in the large branches of the coronary
artery system, in order from the anterior ventricular artery and then
the right coronary artery and the artery.
Research on coronary stenosis in the stages of chronic
obstructive pulmonary disease (Table 3.30) shows that: phase II met
the highest rate of coronary artery stenosis (55.4%) followed by stage
III ( 28.6%) and Stage IV has the lowest rate (16.1%). In stage II of
the disease, LAD branch lesions were the most common (41.9%),
followed by RCA (35.5%), at least LM (3.2%). Stage III, the most
common RCA lesion (43.8%), followed by the LAD arm (31.3%),
the LCX arm accounted for the lowest rate (25%), no patients had
lesions at LM. Stage IV often had lesions in LAD (44.5%), followed
by RCA (33.3%), LCX lesions 22.2% and no patients had lesions in
LM arm. Thus, coronary artery damage in the stages of chronic
obstructive pulmonary disease is also the most significant LAD
branch lesion, followed by RCA and LCX damage accounted for the
lowest rate.

The study of the location of coronary artery lesion with
subtypes of chronic obstructive pulmonary disease (table 3.31)
showed that: group A had no patients with coronary artery lesions.
Group B and group C both have coronary artery lesions and account
for similar proportions between branches. Group D has no LM arm
injury, and the percentage of lesions in the remaining branches is
lower than in group B and group C. This is understandable because
there have been studies of associations between chronic obstructive
pulmonary disease and coronary artery disease. the more severe the
chronic obstructive pulmonary the more calcification and the worse
coronary artery damage. Particularly in group D, the rate of coronary
artery lesions is low because this group is high-risk, symptomatic,
exacerbated in 12 months and often hospitalized for intensive care, so


23

patients in this group are few, has not yet accurately reflected the rate
of coronary artery damage.
Similar to blood biochemical results and respiratory function
measurements, the results in Table 3.34 show that, among the lesions
on X-ray images, patients with LAD had the highest incidence,
followed by RCA and branches. LM had the lowest incidence:
emphysema and bronchial wall thickening with coronary artery
stenosis, the highest rate was found in LAD arm (37.5%), followed
by RCA (30.4%) and lowest when there is damage in the cleavage
(1.8%); Dirty pulmonary images and redistribution of blood vessels
had the highest rate of coronary artery lesions, with LAD at 28.6%,
followed by RCA at 25% and LCX at the same time. have a rate of
10.7%. The lowest is branch LM (1.8%); The teardrop-shaped heart

usually had the highest rate was the LAD arm (10.7%), followed by
the RCA arm (5.4%), no patients with LM and LCX stenosis and
cardiac / thoracic index> 50% of the highest proportion was narrow
branches RCA and LAD (10.7%), followed by the narrow branches
of LCX (7.2%), the lowest proportion of branches LM (1.8%).
In summary, our study has identified the relationship between
blood biochemistry, blood gases, pulmonary ventilation and
pulmonary Xq. The highest proportion of coronary artery stenosis
and lesions is still LAD and RCA. .
Particularly, the relationship between the echocardiography
results in coronary artery stenosis in Table 3.35 shows that most of
the measurements on echocardiogram are not the same as the results
of coronary artery stenosis in blood biochemistry, blood gas and
Lung X-ray: right ventricular diameter increased most in the LM
segment (44.6%), followed by the LCX arm (41.1%) and the least
LAD arm (12.5% 0.Dd was most increased in the segment). the
segment of RCA (32.1%), followed by the branch LM and LCX
(16.1%) and at least the branch LAD (7.2%) and EF dropped the


24

most in the segment LM and LCX (17.9%) ), followed by RCA
(14.3%), the lowest was LAD (10.7%) .The results in table 3.36
showed that there was no coronary injury in patients without
increased dynamic pressure. Pulmonary hypertension Moderate and
moderate increase in pulmonary artery pressure, most common is
LAD (7 , 2% and 19.6%), followed by RCA (3.6% and 10.7%). LCX
episodes were most common in patients with the highest average SBP
pressure (37 , 7 ± 18.6 mmHg), RCA lesions were observed in

patients with mean pulmonary artery pressure index 36.1 ± 14.0
CONCLUSION
1. Clinical characteristics, ECG, echocardiography and some
cardiovascular diseases in patients with chronic obstructive
pulmonary disease
- The prevalence of chronic cardiovascular disease in chronic
obstructive pulmonary disease: hypertension (84%), arrhythmia
(45.1%), ischemic heart disease (57.4%), Chronic heart defects
(46.3%), heart failure (50.6%).
- ECG: Atrial fibrillation 6.8%, ischemic heart disease
53.1%, ischemic heart disease accounts for 53.1%, right bundle
branch block is 30.2% and left bundle branch block is 1.9%.
- Echocardiography: Echocardiography has more diagnostic
value of right ventricular hypertrophy on the ECG: right ventricular
diameter increases on echocardiography 35.8% and right ventricular
thickening on ECG only 19.8%.
2. Computerized tomography of coronary arteries in patients
with chronic obstructive pulmonary disease
2.1. Coronary lesions in patients with chronic obstructive
pulmonary disease


25

- 51.8% of patients had one coronary stenosis, 28.6% had 2
coronary stenosis and all 3 branches were 17.9%.
- Stenosis of the common coronary artery 60.7%, LAD
branch 35.7%; RCA30.4%; LCX 10.7% and 1.8% have LM.
- Severe coronary artery injury and degree of calcification
both had the most significant ventricular artery bypass (LAD)

damage, followed by the right coronary artery (RCA) and
exponential artery damage (LCX) account for a lower percentage.
The lowest is the left common coronary trunk (LM)
2.2. Relationship between coronary artery lesions on polyclinism
and clinical, subclinical in patients with chronic obstructive
pulmonary disease
Determining the correlation between clinical and subclinical
coronary lesions in patients with chronic obstructive pulmonary
disease, the highest incidence is still LAD and RCA. Particularly for
measurements on echocardiography (right ventricular diameter, Dd,
EF, systolic pulmonary pressure) do not give the above results.
The determination of coronary artery stenosis that greatly affects
the severity and severity of chronic obstructive pulmonary disease
and the more severe the chronic obstructive pulmonary disease, the
greater the risk of coronary artery stenosis.
RECOMMENDATION
Chronic obstructive pulmonary disease and cardiovascular
disease often work together and increase the severity of both.
Therefore, comprehensive examination and testing to screen and
detect early cardiovascular manifestations in patients with chronic
obstructive pulmonary disease is necessary to contribute to diagnosis,