Patients with MM, in whom, according to echocardiographic studies, an increase in SrDLA is diagnosed, these are patients with a pronounced destructive process in the bones, including the ribs, sternum, and thoracic spine. Some of them had significant chest deformity. Violation of the chest excursion (due to the osteodestructive process) is an important reason contributing to the development of hypoxemia and an increase in pressure in the aircraft system. In addition to hypoxemia, endothelial dysfunction and, in the presence of CRF, acidosis contribute to the development of PH in patients with MM without broncho-obstructive syndrome (the pH value of blood in patients of group III was on average 7.24 ± 0.03).
Indicators SrDLA in patients with MM, without broncho-obstructive process.
TMPS PZHD increases in patients of group II and reaches maximum values in group III. The CRV of the pancreas reaches significant differences, compared with the control, only in group III. A study of the functional capacity of the right heart in patients of group I was diagnosed with a significant decrease in the ratio of E / A TK compared with the control, i.e. already in the early stages of the tumor diastolic dysfunction of the pancreas is formed. Patients of group II were diagnosed with a decrease in E TK and an increase in A TK , reducing the ratio of E / A. In group III, more significant impairments of pulmonary hemodynamics were revealed. Marked hypertrophy and dilatation of all cavities of the heart. Reduced ejection fraction of the pancreas. KDO and CSR RV were increased. Increased cardiac index of the pancreas, which is associated with an increase in heart rate in the terminal stage of hemoblastosis due to uremic intoxication and anemia. Revealed a reliable decrease in E TK , an increase in A TK and a decrease in the E / A ratio. Thus, in patients with MM in the presence of CRF, the greatest changes in the systolic and diastolic functions of the pancreas were observed .
TMZS LVZh increased already in patients of group I. In the process of tumor progression, it continues to increase, reaching maximum values in group III. The thickness of the interventricular septum is increased in patients with groups II and III. In group I patients, the E / A MK ratio decreased ; LV diastolic dysfunction has occurred. In the process of tumor progression, the ratio of E / A MK continued to decline. Severe dilatation of the LV was diagnosed only in the presence of CRF (group III). In patients of group III, a significant increase in LV size and their corresponding volumes was observed compared with the control group . In the process of tumor howling progression (II and III group) increased MO LV SI LV after effect of increasing heart rate. LV EF was reduced only in patients with MM in the presence of renal failure .
The revealed changes can be explained by impaired blood rheology due to paraproteinemia, cardiotoxic effects of cytostatics, tumor intoxication, anemia, lymphoid and plasma cell infiltration of the myocardium. But dilatation of the cavities of both ventricles, an increase in their size and corresponding volumes, a decrease in the ejection fraction are diagnosed only in patients with MM with chronic renal failure. Many patients with MM are elderly people, they have coronary heart disease diagnosed , which also contributed to the violation of the LV myocardium trophism and the development of circulatory failure.
Thus, it can be concluded that the development of pulmonary hypertension in MM is promoted by: 1) hypoxemia due to impaired excursion of the chest and diaphragm, severe inflammatory and specific paraproteinemic and uremic processes in the lungs, and impaired blood rheology Ic in the vessels of the ICC, 2) endothelial dysfunction, 3) myocardial degeneration, 4) in the presence of renal failure – acidosis.