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Острая сердечная недостаточность: классификация, диагностика, общие подходы к лечению
Жиров И.В., Насонова С.Н., Халилова У.А., Осмоловская Ю.Ф., Чайковская О.Я, Жирова И.А., Гимадиев Р.Р., Кочетов А.Г., Терещенко С.Н. Острая сердечная недостаточность: классификация, диагностика, общие подходы к лечению. Consilium Medicum. 2021; 23 (10): 750–755. DOI: 10.26442/20751753.2021.10.200980
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Zhirov IV, Nasonova SN, Khalilova UA, Osmolovskaya YuF, Chaikovskaia OIa, Zhirova IA, Gimadiev RR, Kochetov AG, Tereshchenko SN. Acute heart failure: classification, diagnosis, general approaches to treatment. Consilium Medicum. 2021; 23 (10): 750–755.
DOI: 10.26442/20751753.2021.10.200980
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Аннотация
Острая сердечная недостаточность (СН) представляет собой синдром, требующий неотложной терапии. Вследствие резкого увеличения числа пациентов с СН эта проблема остается крайне актуальной для современного здравоохранения и имеет значимое влияние на заболеваемость и смертность. В данной статье представлены современные подходы к классификации этого состояния, описаны диагностические алгоритмы, разобраны общие методы терапии острой СН. Дано описание двух клинических осей – наличия застоя в одном или двух кругах кровообращения и периферической гипоперфузии, на основании чего разрабатываются индивидуальные подходы к стратегии лечения пациентов с этим симптомокомплексом.
Ключевые слова: острая сердечная недостаточность, классификация клинической тяжести, гипоперфузия, натрийуретические пептиды
Ключевые слова: острая сердечная недостаточность, классификация клинической тяжести, гипоперфузия, натрийуретические пептиды
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Acute heart failure (HF) is a syndrome requiring urgent treatment. Due to drastic increase in the number of HF patients this problem is still of great importance for modern public health care and has a significant impact on morbidity and mortality. This article presents modern approaches to the classification of this condition, describes diagnostic algorithms, and discovers general methods of acute HF therapy. Two clinical axes are described –
the presence of stasis in one or two circuits of blood circulation and peripheral hypoperfusion, on the basis of which the individual approaches to treatment strategy of patients with this symptom complex are developed.
Key words: acute heart failure, clinical severity classification, hypoperfusion, natriuretic peptides
Полный текст
Список литературы
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4. Mueller C, McDonald K, de Boer RA, et al. Heart Failure Association of the European Society of Cardiology. Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations. Eur J Heart Fail. 2019;21(6):715-31. DOI:10.1002/ejhf.1494
5. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37:2129-200. DOI:10.1093/eurheartj/ehw128
6. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol. 2017;70(6):776-803.
7. Bjork JB, Alton KK, Georgiopoulou VV, et al. Defining advanced heart failure: a systematic review of criteria used in clinical trials. J Card Fail. 2016;22:569-77.
8. Harjola VP, Mullens W, Banaszewski M, et al. Organ dysfunction, injury and failure in acute heart failure: from pathophysiology to diagnosis and management. Eur J Heart Fail. 2017;19:821-36.
9. Hummel YM, Liu LCY, Lam CSP, et al. Echocardiographic estimation of left ventricular and pulmonary pressures in patients with heart failure and preserved ejection fraction: a study utilizing simultaneous echocardiography and invasive measurements. Eur J Heart Fail. 2017;19:1651-60.
10. Quiñones MA, Greenberg BH, Kopelen HA, et al. Echocardiographic predictors of clinical outcome in patients with left ventricular dysfunction enrolled in the SOLVD registry and trials: significance of left ventricular hypertrophy. Studies of Left Ventricular Dysfunction. J Am Coll Cardiol. 2000;35:1237-44.
11. Wong M, Staszewsky L, Latini R, et al. Severity of left ventricular remodeling defines outcomes and response to therapy in heart failure: Valsartan Heart Failure Trial (Val-HeFT) echocardiographic data. J Am Coll Cardiol. 2004;43:2022-7.
12. Perna ER, Macin SM, Canella JP, et al. Ongoing myocardial injury in stable severe heart failure: value of cardiac troponin T monitoring for high-risk patient identification. Circulation. 2004;110:2376-82.
13. Fonarow GC, Peacock WF, Phillips CO, et al. Admission B-type natriuretic peptide levels and in-hospital mortality in acute decompensated heart failure. J Am Coll Cardiol. 2007;49:1943-50.
14. Pascual-Figal DA, Manzano-Fernandez S, Boronat M, et al. Soluble ST2, high-sensitivity troponin T- and N-terminal pro-B-type natriuretic peptide: complementary role for risk stratification in acutely decompensated heart failure. Eur J Heart Fail. 2011;13:718-25.
15. Smith GL, Lichtman JH, Bracken MB, et al. Renal impairment and outcomes in heart failure: systematic review and meta-analysis. J Am Coll Cardiol. 2006;47:1987-96.
16. Van Spall HGC, Rahman T, Mytton O, et al. Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: a systematic review and network meta-analysis. Eur J Heart Fail. 2017;19:1427-43.
17. Ertl G, Angermann CE, Bekeredjian R, et al. Aufbau und Organisation von Herzinsuffizienz-Netzwerken (HF-NETs) und Herzinsuffizienz-Einheiten (“Heart Failure Units”, HFUs) zur Optimierung der Behandlung der akuten und chronischen Herzinsuffizienz. Der Kardiologe. 2016;10:222-35.
2. Терещенко С.Н., Жиров И.В., Ускач Т.М., и др. Клинические рекомендации Евразийской ассоциации кардиологов (ЕАК). Национальное общество специалистов по заболеваниям миокарда и сердечной недостаточности (НОИСН) по диагностике и лечению хронической сердечной недостаточности (2020). Евразийский кардиологический журнал. 2020;3:6-76 [Tereshchenko SN, Zhirov IV, Uskach TM, et al. Klinicheskie rekomendatsii Evraziiskoi assotsiatsii kardiologov (EAK). Natsionalnoe obshchestvo spetsialistov po zabolevaniiam miokarda i serdechnoi nedostatochnosti (NOISN) po diagnostike i lecheniiu khronicheskoi serdechnoi nedostatochnosti (2020). Evraziiskii kardiologicheskii zhurnal. 2020;3:6-76 (in Russian)].
3. Ezekowitz JA, O'Meara E, McDonald MA, et al. 2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure. Can J Cardiol. 2017;33(11):1342-433.
4. Mueller C, McDonald K, de Boer RA, et al. Heart Failure Association of the European Society of Cardiology. Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations. Eur J Heart Fail. 2019;21(6):715-31. DOI:10.1002/ejhf.1494
5. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37:2129-200. DOI:10.1093/eurheartj/ehw128
6. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol. 2017;70(6):776-803.
7. Bjork JB, Alton KK, Georgiopoulou VV, et al. Defining advanced heart failure: a systematic review of criteria used in clinical trials. J Card Fail. 2016;22:569-77.
8. Harjola VP, Mullens W, Banaszewski M, et al. Organ dysfunction, injury and failure in acute heart failure: from pathophysiology to diagnosis and management. Eur J Heart Fail. 2017;19:821-36.
9. Hummel YM, Liu LCY, Lam CSP, et al. Echocardiographic estimation of left ventricular and pulmonary pressures in patients with heart failure and preserved ejection fraction: a study utilizing simultaneous echocardiography and invasive measurements. Eur J Heart Fail. 2017;19:1651-60.
10. Quiñones MA, Greenberg BH, Kopelen HA, et al. Echocardiographic predictors of clinical outcome in patients with left ventricular dysfunction enrolled in the SOLVD registry and trials: significance of left ventricular hypertrophy. Studies of Left Ventricular Dysfunction. J Am Coll Cardiol. 2000;35:1237-44.
11. Wong M, Staszewsky L, Latini R, et al. Severity of left ventricular remodeling defines outcomes and response to therapy in heart failure: Valsartan Heart Failure Trial (Val-HeFT) echocardiographic data. J Am Coll Cardiol. 2004;43:2022-7.
12. Perna ER, Macin SM, Canella JP, et al. Ongoing myocardial injury in stable severe heart failure: value of cardiac troponin T monitoring for high-risk patient identification. Circulation. 2004;110:2376-82.
13. Fonarow GC, Peacock WF, Phillips CO, et al. Admission B-type natriuretic peptide levels and in-hospital mortality in acute decompensated heart failure. J Am Coll Cardiol. 2007;49:1943-50.
14. Pascual-Figal DA, Manzano-Fernandez S, Boronat M, et al. Soluble ST2, high-sensitivity troponin T- and N-terminal pro-B-type natriuretic peptide: complementary role for risk stratification in acutely decompensated heart failure. Eur J Heart Fail. 2011;13:718-25.
15. Smith GL, Lichtman JH, Bracken MB, et al. Renal impairment and outcomes in heart failure: systematic review and meta-analysis. J Am Coll Cardiol. 2006;47:1987-96.
16. Van Spall HGC, Rahman T, Mytton O, et al. Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: a systematic review and network meta-analysis. Eur J Heart Fail. 2017;19:1427-43.
17. Ertl G, Angermann CE, Bekeredjian R, et al. Aufbau und Organisation von Herzinsuffizienz-Netzwerken (HF-NETs) und Herzinsuffizienz-Einheiten (“Heart Failure Units”, HFUs) zur Optimierung der Behandlung der akuten und chronischen Herzinsuffizienz. Der Kardiologe. 2016;10:222-35.
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1. Tereshchenko SN, Galiavich AS, Uskach TM, et al. Khronicheskaia serdechnaia nedostatochnost. Klinicheskie rekomendatsii 2020. Rossiiskii kardiologicheskii zhurnal. 2020;25(11):311-74 (in Russian). DOI:10.15829/1560-4071-2020-4083
2. Tereshchenko SN, Zhirov IV, Uskach TM, et al. Klinicheskie rekomendatsii Evraziiskoi assotsiatsii kardiologov (EAK). Natsionalnoe obshchestvo spetsialistov po zabolevaniiam miokarda i serdechnoi nedostatochnosti (NOISN) po diagnostike i lecheniiu khronicheskoi serdechnoi nedostatochnosti (2020). Evraziiskii kardiologicheskii zhurnal. 2020;3:6-76 (in Russian).
3. Ezekowitz JA, O'Meara E, McDonald MA, et al. 2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure. Can J Cardiol. 2017;33(11):1342-433.
4. Mueller C, McDonald K, de Boer RA, et al. Heart Failure Association of the European Society of Cardiology. Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations. Eur J Heart Fail. 2019;21(6):715-31. DOI:10.1002/ejhf.1494
5. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37:2129-200. DOI:10.1093/eurheartj/ehw128
6. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol. 2017;70(6):776-803.
7. Bjork JB, Alton KK, Georgiopoulou VV, et al. Defining advanced heart failure: a systematic review of criteria used in clinical trials. J Card Fail. 2016;22:569-77.
8. Harjola VP, Mullens W, Banaszewski M, et al. Organ dysfunction, injury and failure in acute heart failure: from pathophysiology to diagnosis and management. Eur J Heart Fail. 2017;19:821-36.
9. Hummel YM, Liu LCY, Lam CSP, et al. Echocardiographic estimation of left ventricular and pulmonary pressures in patients with heart failure and preserved ejection fraction: a study utilizing simultaneous echocardiography and invasive measurements. Eur J Heart Fail. 2017;19:1651-60.
10. Quiñones MA, Greenberg BH, Kopelen HA, et al. Echocardiographic predictors of clinical outcome in patients with left ventricular dysfunction enrolled in the SOLVD registry and trials: significance of left ventricular hypertrophy. Studies of Left Ventricular Dysfunction. J Am Coll Cardiol. 2000;35:1237-44.
11. Wong M, Staszewsky L, Latini R, et al. Severity of left ventricular remodeling defines outcomes and response to therapy in heart failure: Valsartan Heart Failure Trial (Val-HeFT) echocardiographic data. J Am Coll Cardiol. 2004;43:2022-7.
12. Perna ER, Macin SM, Canella JP, et al. Ongoing myocardial injury in stable severe heart failure: value of cardiac troponin T monitoring for high-risk patient identification. Circulation. 2004;110:2376-82.
13. Fonarow GC, Peacock WF, Phillips CO, et al. Admission B-type natriuretic peptide levels and in-hospital mortality in acute decompensated heart failure. J Am Coll Cardiol. 2007;49:1943-50.
14. Pascual-Figal DA, Manzano-Fernandez S, Boronat M, et al. Soluble ST2, high-sensitivity troponin T- and N-terminal pro-B-type natriuretic peptide: complementary role for risk stratification in acutely decompensated heart failure. Eur J Heart Fail. 2011;13:718-25.
15. Smith GL, Lichtman JH, Bracken MB, et al. Renal impairment and outcomes in heart failure: systematic review and meta-analysis. J Am Coll Cardiol. 2006;47:1987-96.
16. Van Spall HGC, Rahman T, Mytton O, et al. Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: a systematic review and network meta-analysis. Eur J Heart Fail. 2017;19:1427-43.
17. Ertl G, Angermann CE, Bekeredjian R, et al. Aufbau und Organisation von Herzinsuffizienz-Netzwerken (HF-NETs) und Herzinsuffizienz-Einheiten (“Heart Failure Units”, HFUs) zur Optimierung der Behandlung der akuten und chronischen Herzinsuffizienz. Der Kardiologe. 2016;10:222-35.
Авторы
И.В. Жиров*1,2, С.Н. Насонова1, У.А. Халилова3, Ю.Ф. Осмоловская1, О.Я. Чайковская1, И.А. Жирова3, Р.Р. Гимадиев3, А.Г. Кочетов3,4, С.Н. Терещенко1,2
1 ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
2 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
3 ФГАОУ ВО «Российский университет дружбы народов», Москва, Россия;
4 АНО ДПО «Институт лабораторной медицины», Москва, Россия
*izhirov@mail.ru
1 ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
2 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
3 ФГАОУ ВО «Российский университет дружбы народов», Москва, Россия;
4 АНО ДПО «Институт лабораторной медицины», Москва, Россия
*izhirov@mail.ru
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Igor V. Zhirov*1,2, Svetlana N. Nasonova1, Ulkiar A. Khalilova3, Yulia F. Osmolovskaya1, Olga Ia. Chaikovskaia1, Irina A. Zhirova3, Rinat R. Gimadiev3, Anatolii G. Kochetov3,4, Sergei N. Tereshchenko1,2
1 National Medical Research Center of Cardiology, Moscow, Russia;
2 Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
3 People’s Friendship University of Russia (RUDN University), Moscow, Russia;
4 Institute of Laboratory Medicine, Moscow, Russia
*izhirov@mail.ru
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