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Актуальность назначения тройной нейрогормональной блокады в условиях реальной клинической практики: роль антагонистов минералокортикоидных рецепторов
Жиров И.В. Актуальность назначения тройной нейрогормональной блокады в условиях реальной клинической практики: роль антагонистов минералокортикоидных рецепторов. Consilium Medicum. 2021; 23 (6): 491–497. DOI: 10.26442/20751753.2021.6.200889
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Zhirov IV. The relevance of prescribing triple neurohormonal blockade in real clinical practice: the role of mineralocorticoid receptor antagonists. Consilium Medicum. 2021; 23 (6): 491–497. DOI: 10.26442/20751753.2021.6.200889
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Аннотация
В статье рассмотрены современные представления о роли антагонистов минералокортикоидных рецепторов, и в частности эплеренона,
в лечении сердечно-сосудистых заболеваний. Приведены результаты рандомизированных клинических исследований, отмечено место представителей данного класса в современных клинических рекомендациях по лечению острого инфаркта миокарда и хронической сердечной недостаточности.
Ключевые слова: хроническая сердечная недостаточность, антагонисты минералокортикоидных рецепторов, острый инфаркт миокарда, эплеренон
в лечении сердечно-сосудистых заболеваний. Приведены результаты рандомизированных клинических исследований, отмечено место представителей данного класса в современных клинических рекомендациях по лечению острого инфаркта миокарда и хронической сердечной недостаточности.
Ключевые слова: хроническая сердечная недостаточность, антагонисты минералокортикоидных рецепторов, острый инфаркт миокарда, эплеренон
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In the article is outlined the main concepts use of the mineralocorticoids receptors antagonists in the treatment of congestive heart failure and systolic dysfunction after acute myocardial infarction. Claimed the pivotal role of eplerenone in the long-term treatment strategy due to decrease of mortality and improving the clinical outcomes.
Keywords: congestive heart failure, mineralocorticoid receptors antagonists, acute myocardial infarction, eplerenone
Полный текст
Список литературы
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3. Ponikowski P, Anker S, Al Habib K, et al. Heart failure: preventing disease and death worldwide: Addressing heart failure. ESC Heart Failure. 2014;1(1):4-25. DOI:10.1002/ehf2.12005
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12. Degasparo M, Joss U, Ramjoue A, et al. Three new epoxy-spironolactone derivates: characterization in vivo and in vitro. J Pharmacol Exp Ther. 1987;240:650-6.
13. Delyani J, Myles K, Funder J, et al. Eplerenone (SC 66110), a highly selective aldosteron antagonist. Am J Hypertens. 1998;11:94A.
14. Терещенко С.Н., Жиров И.В. Хроническая сердечная недостаточность. В кн.: Руководство по кардиологии. Под ред. Е.И. Чазова. Т. 4. М.: Практика, 2014; c. 192-291 [Tereshchenko SN, Zhirov IV. Khronicheskaia serdechnaia nedostatochnost’. In: Rukovodstvo po kardiologii. Ed. EI Chazov. V. 4. M.: Praktika, 2014; p. 192-291 (in Russian)].
15. Lee A, MacFadyen R, Struthers A. Neurohormonal reactivationin heart failure patients on chronic ACE inhibitor therapy: a longitudinal study. Eur J Heart Fail. 1999;1(4):401-6.
16. Guichard J, Clark D III, Calhoun D, Ahmed M. Aldosterone receptor antagonists: current perspectives and therapies. Vasc Health Risk Manag. 2013:9 321-31.
17. Терещенко С.Н., Жиров И.В., Осмоловская Ю.Ф. Антагонисты минералокортикоидных рецепторов в лечении больных с сердечной недостаточностью после инфаркта миокарда с хронической сердечной недостаточностью. Терапевтический архив. 2013;85(12):137-44 [Tereshchenko SN, Zhirov IV, Osmolovskaia IuF. Antagonisty mineralokortikoidnykh retseptorov v lechenii bol’nykh s serdechnoi nedostatochnost’iu posle infarkta miokarda s khronicheskoi serdechnoi nedostatochnost’iu. Terapevticheskii Arkhiv (Ter. Arkh). 2013;85(12):137-44 (in Russian)].
18. McMachon E. Recent studies with eplerenone, a novel selective aldosterone receptor antagonist. Curr Opin Pharmacol. 2001;1:190-6.
19. Zannad F, McMurray JJ, Krum H, et al. EMPHASIS-HF Study Group. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364(1):11-21.
20. Zannad F, McMurray JJV, Drexler H, et al. Rationale and design of the Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure (EMPHASIS-HF). Eur J Heart Fail. 2010;12 (6):617-22.
21. Tsutsui H, Ito H, Kitakaze M, et al. Double-Blind, Randomized, Placebo-Controlled Trial Evaluating the Efficacy and Safety of Eplerenone in Japanese Patients With Chronic Heart Failure (J-EMPHASIS-HF). Circ J. 2017;82(1):148-58. DOI:10.1253/circj.CJ-17-0323
22. Ferreira J, Duarte K, McMurray J, et al. Data-Driven Approach to Identify Subgroups of Heart Failure With Reduced Ejection Fraction Patients With Different Prognoses and Aldosterone Antagonist Response Patterns. Circ Heart Fail. 2018;11(7):e004926. DOI:10.1161/CIRCHEARTFAILURE.118.004926
23. Rossignol P, Girerd N, Bakris G, et al. Impact of Eplerenone on Cardiovascular Outcomes in Heart Failure Patients With Hypokalaemia. Eur J Heart Fail. 2017;19(6):792-9. DOI: 10.1002/ejhf.688
24. Chin K, Collier T, Pocock S, et al. Impact of eplerenone on major cardiovascular outcomes in patients with systolic heart failure according to baseline heart rate. Clin Res Cardiol. 2019;108(7):806-14. DOI:10.1007/s00392-018-1410-4
25. Ademi Z, Pasupathi K, Liew D. Cost-Effectiveness of Eplerenone Compared to Usual Care in Patients With Chronic Heart Failure and NYHA Class II Symptoms, an Australian Perspective. Medicine (Baltimore). 2016;95(18):e3531. DOI:10.1097/MD.0000000000003531
26. Athanasakis K, Bilitou A, Lee D, et al. Cost-effectiveness of Eplerenone in NYHA Class II Chronic Heart Failure Patients With Reduced LVEF: An Analysis for Greece. Clinicoecon Outcomes Res. 2016;8:583-90. DOI:10.2147/CEOR.S107831
27. Girerd N, Collier T, Pocock S, et al. Clinical benefits of eplerenone in patients with systolic heart failure and mild symptoms when initiated shortly after hospital discharge: analysis from the EMPHASIS-HF trial. Eur Heart J. 2015;36(34):2310-7.
28. Pitt B, Remme W, Zannad F, et al. Eplerenone, a Selective Aldosterone Blocker, in Patients with Left Ventricular Dysfunction after Myocardial Infarction. N Engl J Med. 2003;348:1309-21.
29. Beygui F, Van Belle E, Ecollan P, et al. Individual participant data analysis of two trials on aldosterone blockade in myocardial infarction. Heart. 2018;104(22):1843-9. DOI:10.1136/heartjnl-2018-312950
30. Montalescot G, Pitt B, Lopez de Sa E, et al., REMINDER Investigators. Early eplerenone treatment in patients with acute ST-elevation myocardial infarction without heart failure: the Randomized Double-Blind Reminder Study. Eur Heart J. 2014;35(34):2295-302.
31. Pitt B, Zannad F, Remme W, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med. 1999;341:709-17.
32. Мареев В.Ю., Скворцов А.А. Блокада эффектов альдостерона у больных сердечной недостаточностью: современный взгляд на проблему – эплеренон (часть II). Журнал Сердечная Недостаточность. 2011;12(4):222-7 [Mareev VIu, Skvortsov AA. Blokada effektov al’dosterona u bol’nykh serdechnoi nedostatochnost’iu: sovremennyi vzgliad na problemu – eplerenon (chast’ II). Zhurnal Serdechnaia Nedostatochnost’. 2011;12(4):222-7 (in Russian)].
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40. Диагностика и лечение больных острым инфарктом миокарда с подъемом сегмента ST электрокардиограммы. Режим доступа: http://acutecardio.ru/sadm_files/recommendations/STEACS_2.pdf [Diagnostika i lechenie bol’nykh ostrym infarktom miokarda s pod”emom segmenta ST elektrokardiogrammy. Available at: http://acutecardio.ru/sadm_files/recommendations/STEACS_2.pdf (in Russian)].
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2. Терещенко С.Н., Жиров И.В., Нарусов О.Ю., и др. Диагностика и лечение хронической и острой сердечной недостаточности. Кардиологический вестн. 2016;2:3-33 [Tereshchenko SN, Zhirov IV, Narusov OIu, et al. Diagnostika i lechenie khronicheskoi i ostroi serdechnoi nedostatochnosti. Kardiologicheskii vestn. 2016;2:3-33 (in Russian)].
3. Ponikowski P, Anker S, Al Habib K, et al. Heart failure: preventing disease and death worldwide: Addressing heart failure. ESC Heart Failure. 2014;1(1):4-25. DOI:10.1002/ehf2.12005
4. Levy D, Kenchaiah S, Larson M, et al. Long-term trends in the incidence of and survival with heart failure. N Engl J Med. 2002;347:1397-402.
5. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics – 2016 Update: A Report from the American Heart Association. Circulation. 2016;133(4):e38-360. DOI:10.1161/CIR.0000000000000350
6. Ситникова М.Ю., Юрченко А.В., Лясникова Е.А., и др. Результаты Российского госпитального регистра хронической сердечной недостаточности в 3 субъектах Российской Федерации. Кардиология. 2015;55(10):13-21 [Sitnikova MIu, Iurchenko AV, Liasnikova EA, et al. Rezul’taty Rossiiskogo gospital’nogo registra khronicheskoi serdechnoi nedostatochnosti v 3 sub”ektakh Rossiiskoi Federatsii. Kardiologiia. 2015;55(10):13-21 (in Russian)].
7. Арутюнов А.Г., Рылова А.К., Арутюнов Г.П. Регистр госпитализированных пациентов с декомпенсацией кровообращения (регистр Павловской больницы). Сообщение 2. Клиническое значение и прогностическая роль некоторых параметров, определяемых при физикальном и инструментальном обследовании пациентов с декомпенсацией кровообращения. Журнал Сердечная Недостаточность. 2014;15(2):67-75 [Arutiunov AG, Rylova AK, Arutiunov GP. Registr gospitalizirovannykh patsientov s dekompensatsiei krovoobrashcheniia (registr Pavlovskoi bol’nitsy). Soobshchenie 2. Klinicheskoe znachenie i prognosticheskaia rol’ nekotorykh parametrov, opredeliaemykh pri fizikal’nom i instrumental’nom obsledovanii patsientov s dekompensatsiei krovoobrashcheniia. Zhurnal Serdechnaia Nedostatochnost’. 2014;15(2):67-75 (in Russian)].
8. Ponikowski P, Voors A, Anker S, 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
9. Yancy C, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guidelines for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Assiciation Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147-e239.
10. Arriza JL, Weinberger C, Cerelli G, et al. Cloning of human mineralocorticoid receptor complementory DNA: structural and functional kinship with the glucocorticoid receptor. Science. 1987;237(4812):268-75.
11. Cook CS, Berry LM, Kim DH, et al. Involvement of CYP3A in the metabolism of eplerenone in humans and dogs: differential metabolism by CYP3A4 and CYP3A5. Drug Metab Dispos. 2002;30(12):1344-51.
12. Degasparo M, Joss U, Ramjoue A, et al. Three new epoxy-spironolactone derivates: characterization in vivo and in vitro. J Pharmacol Exp Ther. 1987;240:650-6.
13. Delyani J, Myles K, Funder J, et al. Eplerenone (SC 66110), a highly selective aldosteron antagonist. Am J Hypertens. 1998;11:94A.
14. Терещенко С.Н., Жиров И.В. Хроническая сердечная недостаточность. В кн.: Руководство по кардиологии. Под ред. Е.И. Чазова. Т. 4. М.: Практика, 2014; c. 192-291 [Tereshchenko SN, Zhirov IV. Khronicheskaia serdechnaia nedostatochnost’. In: Rukovodstvo po kardiologii. Ed. EI Chazov. V. 4. M.: Praktika, 2014; p. 192-291 (in Russian)].
15. Lee A, MacFadyen R, Struthers A. Neurohormonal reactivationin heart failure patients on chronic ACE inhibitor therapy: a longitudinal study. Eur J Heart Fail. 1999;1(4):401-6.
16. Guichard J, Clark D III, Calhoun D, Ahmed M. Aldosterone receptor antagonists: current perspectives and therapies. Vasc Health Risk Manag. 2013:9 321-31.
17. Терещенко С.Н., Жиров И.В., Осмоловская Ю.Ф. Антагонисты минералокортикоидных рецепторов в лечении больных с сердечной недостаточностью после инфаркта миокарда с хронической сердечной недостаточностью. Терапевтический архив. 2013;85(12):137-44 [Tereshchenko SN, Zhirov IV, Osmolovskaia IuF. Antagonisty mineralokortikoidnykh retseptorov v lechenii bol’nykh s serdechnoi nedostatochnost’iu posle infarkta miokarda s khronicheskoi serdechnoi nedostatochnost’iu. Terapevticheskii Arkhiv (Ter. Arkh). 2013;85(12):137-44 (in Russian)].
18. McMachon E. Recent studies with eplerenone, a novel selective aldosterone receptor antagonist. Curr Opin Pharmacol. 2001;1:190-6.
19. Zannad F, McMurray JJ, Krum H, et al. EMPHASIS-HF Study Group. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364(1):11-21.
20. Zannad F, McMurray JJV, Drexler H, et al. Rationale and design of the Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure (EMPHASIS-HF). Eur J Heart Fail. 2010;12 (6):617-22.
21. Tsutsui H, Ito H, Kitakaze M, et al. Double-Blind, Randomized, Placebo-Controlled Trial Evaluating the Efficacy and Safety of Eplerenone in Japanese Patients With Chronic Heart Failure (J-EMPHASIS-HF). Circ J. 2017;82(1):148-58. DOI:10.1253/circj.CJ-17-0323
22. Ferreira J, Duarte K, McMurray J, et al. Data-Driven Approach to Identify Subgroups of Heart Failure With Reduced Ejection Fraction Patients With Different Prognoses and Aldosterone Antagonist Response Patterns. Circ Heart Fail. 2018;11(7):e004926. DOI:10.1161/CIRCHEARTFAILURE.118.004926
23. Rossignol P, Girerd N, Bakris G, et al. Impact of Eplerenone on Cardiovascular Outcomes in Heart Failure Patients With Hypokalaemia. Eur J Heart Fail. 2017;19(6):792-9. DOI: 10.1002/ejhf.688
24. Chin K, Collier T, Pocock S, et al. Impact of eplerenone on major cardiovascular outcomes in patients with systolic heart failure according to baseline heart rate. Clin Res Cardiol. 2019;108(7):806-14. DOI:10.1007/s00392-018-1410-4
25. Ademi Z, Pasupathi K, Liew D. Cost-Effectiveness of Eplerenone Compared to Usual Care in Patients With Chronic Heart Failure and NYHA Class II Symptoms, an Australian Perspective. Medicine (Baltimore). 2016;95(18):e3531. DOI:10.1097/MD.0000000000003531
26. Athanasakis K, Bilitou A, Lee D, et al. Cost-effectiveness of Eplerenone in NYHA Class II Chronic Heart Failure Patients With Reduced LVEF: An Analysis for Greece. Clinicoecon Outcomes Res. 2016;8:583-90. DOI:10.2147/CEOR.S107831
27. Girerd N, Collier T, Pocock S, et al. Clinical benefits of eplerenone in patients with systolic heart failure and mild symptoms when initiated shortly after hospital discharge: analysis from the EMPHASIS-HF trial. Eur Heart J. 2015;36(34):2310-7.
28. Pitt B, Remme W, Zannad F, et al. Eplerenone, a Selective Aldosterone Blocker, in Patients with Left Ventricular Dysfunction after Myocardial Infarction. N Engl J Med. 2003;348:1309-21.
29. Beygui F, Van Belle E, Ecollan P, et al. Individual participant data analysis of two trials on aldosterone blockade in myocardial infarction. Heart. 2018;104(22):1843-9. DOI:10.1136/heartjnl-2018-312950
30. Montalescot G, Pitt B, Lopez de Sa E, et al., REMINDER Investigators. Early eplerenone treatment in patients with acute ST-elevation myocardial infarction without heart failure: the Randomized Double-Blind Reminder Study. Eur Heart J. 2014;35(34):2295-302.
31. Pitt B, Zannad F, Remme W, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med. 1999;341:709-17.
32. Мареев В.Ю., Скворцов А.А. Блокада эффектов альдостерона у больных сердечной недостаточностью: современный взгляд на проблему – эплеренон (часть II). Журнал Сердечная Недостаточность. 2011;12(4):222-7 [Mareev VIu, Skvortsov AA. Blokada effektov al’dosterona u bol’nykh serdechnoi nedostatochnost’iu: sovremennyi vzgliad na problemu – eplerenon (chast’ II). Zhurnal Serdechnaia Nedostatochnost’. 2011;12(4):222-7 (in Russian)].
33. Margolis J, Gerber R, Roberts C, et al. Adherence to Aldosterone-blocking Agents in Patients with Heart Failure. Am J Therapeutics. 2010;17:446-54.
34. Yancy C, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. JACC. 2017;70(6):776-803.
35. Ezekowitz J, O’Meara E, McDonald M, et al. 2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure. Can J Cardiol. 2017;33:1342-433.
36. Roffi M, Patroo C, Collet J, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267-315. DOI: 10.1093/eurheartj/ehv320
37. Клинические рекомендации по диагностике и лечению больных c острым коронарным синдромом без подъема сегмента ST электрокардиограммы. Режим доступа:
http://acutecardio.ru/sadm_files/recommendations/NSTEACS_1.pdf [Klinicheskie rekomendatsii po diagnostike i lecheniiu bol’nykh c ostrym koronarnym sindromom bez pod”ema segmenta ST elektrokardiogrammy. Available at: http://acutecardio.ru/sadm_files/recommendations/NSTEACS_1.pdf (in Russian)].
38. Amsterdam E, Wenger N, Brindis R, et al. 2014 AHA/ACC Guideline for the Management of patients with non-ST-Elevation Acute Coronary Syndromes. JACC. 2014;64(24):e139-e228.
39. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(21):1991. DOI:10.1093/eurheartj/ehx637
40. Диагностика и лечение больных острым инфарктом миокарда с подъемом сегмента ST электрокардиограммы. Режим доступа: http://acutecardio.ru/sadm_files/recommendations/STEACS_2.pdf [Diagnostika i lechenie bol’nykh ostrym infarktom miokarda s pod”emom segmenta ST elektrokardiogrammy. Available at: http://acutecardio.ru/sadm_files/recommendations/STEACS_2.pdf (in Russian)].
41. O’Gara P, Kushner F, Aschein D, et al. 2013 ACCF/AHA Guideline for the management of ST-Elevation Myocardial Infarction. JACC. 2013;61(4):e78-e140.
42. Терещенко С.Н., Галявич А.С., Ускач Т.М., и др. Хроническая сердечная недостаточность. Клинические рекомендации 2020. Рос. кардиол. журн. 2020;25(11):311-74 [Tereshchenko SN, Galiavich AS, Uskach TM, et al. Khronicheskaia serdechnaia nedostatochnost’. Klinicheskie rekomendatsii 2020. Ros. kardiol. zhurn. 2020;25(11):311-74 (in Russian)]. DOI:10.15829/1560-4071-2020-4083
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28. Pitt B, Remme W, Zannad F, et al. Eplerenone, a Selective Aldosterone Blocker, in Patients with Left Ventricular Dysfunction after Myocardial Infarction. N Engl J Med. 2003;348:1309-21.
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30. Montalescot G, Pitt B, Lopez de Sa E, et al., REMINDER Investigators. Early eplerenone treatment in patients with acute ST-elevation myocardial infarction without heart failure: the Randomized Double-Blind Reminder Study. Eur Heart J. 2014;35(34):2295-302.
31. Pitt B, Zannad F, Remme W, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med. 1999;341:709-17.
32. Mareev VIu, Skvortsov AA. Blokada effektov al’dosterona u bol’nykh serdechnoi nedostatochnost’iu: sovremennyi vzgliad na problemu – eplerenon (chast’ II). Zhurnal Serdechnaia Nedostatochnost’. 2011;12(4):222-7 (in Russian)
33. Margolis J, Gerber R, Roberts C, et al. Adherence to Aldosterone-blocking Agents in Patients with Heart Failure. Am J Therapeutics. 2010;17:446-54.
34. Yancy C, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. JACC. 2017;70(6):776-803.
35. Ezekowitz J, O’Meara E, McDonald M, et al. 2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure. Can J Cardiol. 2017;33:1342-433.
36. Roffi M, Patroo C, Collet J, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267-315. DOI: 10.1093/eurheartj/ehv320
37. Klinicheskie rekomendatsii po diagnostike i lecheniiu bol’nykh c ostrym koronarnym sindromom bez pod”ema segmenta ST elektrokardiogrammy. Available at: http://acutecardio.ru/sadm_files/recommendations/NSTEACS_1.pdf (in Russian)
38. Amsterdam E, Wenger N, Brindis R, et al. 2014 AHA/ACC Guideline for the Management of patients with non-ST-Elevation Acute Coronary Syndromes. JACC. 2014;64(24):e139-e228.
39. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(21):1991. DOI:10.1093/eurheartj/ehx637
40. Diagnostika i lechenie bol’nykh ostrym infarktom miokarda s pod”emom segmenta ST elektrokardiogrammy. Available at: http://acutecardio.ru/sadm_files/recommendations/STEACS_2.pdf (in Russian)
41. O’Gara P, Kushner F, Aschein D, et al. 2013 ACCF/AHA Guideline for the management of ST-Elevation Myocardial Infarction. JACC. 2013;61(4):e78-e140.
42. Tereshchenko SN, Galiavich AS, Uskach TM, et al. Khronicheskaia serdechnaia nedostatochnost’. Klinicheskie rekomendatsii 2020. Ros. kardiol. zhurn. 2020;25(11):311-74 (in Russian) DOI:10.15829/1560-4071-2020-4083
Авторы
И.В. Жиров*
1 ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
2 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, 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
*izhirov@mail.ru
________________________________________________
Igor V. Zhirov*
1 National Medical Research Center of Cardiology, Moscow, Russia;
2 Russian Medical Academy of Continuous Professional Education, Moscow, Russia
*izhirov@mail.ru
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