ssmuБюллетень сибирской медициныBulletin of Siberian Medicine1682-03631819-3684Siberian State Medical University, the Ministry of Healthcare of the Russian Federation10.20538/1682-0363-2022-3-181-197ssmu-4920Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEW AND LECTURESПерспективные направления лечения хронической сердечной недостаточности: совершенствование старых или разработка новых?Promising directions in the treatment of chronic heart failure: improving old or developing new ones?https://orcid.org/0000-0001-9640-2028КалюжинВ. В.KalyuzhinV. V.

Калюжин Вадим Витальевич – доктор медицинских наук, профессор, заведующий кафедрой госпитальной терапии с курсом реабилитации, физиотерапии и спортивной медицины, СибГМУ.

634050, Томск, Московский тракт, 2

2, Moscow Trakt, Tomsk, 634050

kalyuzhinvv@mail.ruhttps://orcid.org/0000-0003-0721-0038ТепляковА. Т.TeplyakovA. T.

Тепляков Александр Трофимович – доктор медицинских наук, профессор, главный научный сотрудник, НИИ кардиологии, Томский НИМЦ.

634012, Томск, ул. Киевская, 111а

111а, Kievskaya Str., Tomsk, 634012

Vgelen1970@gmail.comhttps://orcid.org/0000-0002-4513-6329БеспаловаИ. Д.BespalovaI. D.

Беспалова Инна Давидовна – доктор медицинских наук, профессор кафедры госпитальной терапии с курсом реабилитации, физиотерапии и спортивной медицины, СибГМУ.

634050, Томск, Московский тракт, 2

2, Moscow Trakt, Tomsk, 634050

innadave@mail2000.ruhttps://orcid.org/0000-0002-7978-5327КалюжинаЕ. В.KalyuzhinaE. V.

Калюжина Елена Викторовна – доктор медицинских наук, профессор кафедры госпитальной терапии с курсом реабилитации, физиотерапии и спортивной медицины, СибГМУ.

634050, Томск, Московский тракт, 2

2, Moscow Trakt, Tomsk, 634050

kalyuzhina.e@mail.ruhttps://orcid.org/0000-0002-0462-3526ТерентьеваН. Н.TerentyevaN. N.

Терентьева Надежда Николаевна – кандидат медицинских наук, доцент кафедры внутренних болезней СурГУ.

628412, Сургут, пр. Ленина, 1

1, Lenina Av., Surgut, 628412

nadiater@mail.ruhttps://orcid.org/0000-0003-4019-3735ГраковаЕ. В.GrakovaE. V.

Гракова Елена Викторовна – доктор медицинских наук, ведущий научный сотрудник отделения патологии миокарда НИИ кардиологии, Томский НИМЦ.

634012, Томск, ул. Киевская, 111а

111а, Kievskaya Str., Tomsk, 634012

gev@cardio-tomsk.ruhttps://orcid.org/0000-0002-2285-6438КопьеваК. В.KopevaK. V.

Копьева Кристина Васильевна – кандидат медицинских наук, научный сотрудник отделения патологии миокарда НИИ кардиологии, Томский НИМЦ.

634012, Томск, ул. Киевская, 111а

111а, Kievskaya Str., Tomsk, 634012

kristin-kop@inbox.ruhttps://orcid.org/0000-0001-7978-5514УсовВ. Ю.UsovV. Yu.

Усов Владимир Юрьевич – доктор медицинских наук, профессор, руководитель отделения рентгеновских и томографических методов диагностики, НИИ кардиологии, Томский НИМЦ.

634012, Томск, ул. Киевская, 111а

111а, Kievskaya Str., Tomsk, 634012

ussov1962@yandex.ruhttps://orcid.org/0000-0002-7353-7154ГарганееваН. П.GarganeevaN. P.

Гарганеева Наталья Петровна – доктор медицинских наук, профессор кафедры общей врачебной практики и поликлинической терапии, СибГМУ.

634050, Томск, Московский тракт, 2

2, Moscow Trakt, Tomsk, 634050

garganeeva@gmail.comhttps://orcid.org/0000-0001-6766-3974ПавленкоО. А.PavlenkoO. A.

Павленко Ольга Алексеевна – доктор медицинских наук, профессор кафедры факультетской терапии с курсом клинической фармакологии, СибГМУ.

634050, Томск, Московский тракт, 2

2, Moscow Trakt, Tomsk, 634050

pavlenko.51@mail.ruhttps://orcid.org/0000-0002-8119-9482ГореловаЮ. В.GorelovaYu. V.

Горелова Юнона Валериевна – кандидат медицинских наук, ассистент кафедры госпитальной терапии с курсом реабилитации, физиотерапии и спортивной медицины, СибГМУ.

634050, Томск, Московский тракт, 2

2, Moscow Trakt, Tomsk, 634050

junonag@mail.ruhttps://orcid.org/0000-0002-4323-2798ТетеневаА. В.TetenevaA. V.

Тетенева Анна Валентиновна – доктор медицинских наук, профессор кафедры пропедевтики внутренних болезней с курсом терапии педиатрического факультета, СибГМУ.

634050, Томск, Московский тракт, 2

2, Moscow Trakt, Tomsk, 634050

anna.dubodelova@mail.ruСибирский государственный медицинский университет (СибГМУ)РоссияSiberian State Medical UniversityRussian FederationНаучно-исследовательский институт кардиологии (НИИ кардиологии) Томского национального исследовательского медицинского центра (НИМЦ), Российская академия наукРоссияCardiology Research Institute, Tomsk National Research Medical Center (NRMC), Russian Academy of SciencesRussian FederationСургутский государственный университет (СурГУ)РоссияSurgut State UniversityRussian Federation202215102022213181197Copyright © Калюжин В.В., Тепляков А.Т., Беспалова И.Д., Калюжина Е.В., Терентьева Н.Н., Гракова Е.В., Копьева К.В., Усов В.Ю., Гарганеева Н.П., Павленко О.А., Горелова Ю.В., Тетенева А.В., 20222022Калюжин В.В., Тепляков А.Т., Беспалова И.Д., Калюжина Е.В., Терентьева Н.Н., Гракова Е.В., Копьева К.В., Усов В.Ю., Гарганеева Н.П., Павленко О.А., Горелова Ю.В., Тетенева А.В.Kalyuzhin V.V., Teplyakov A.T., Bespalova I.D., Kalyuzhina E.V., Terentyeva N.N., Grakova E.V., Kopeva K.V., Usov V.Y., Garganeeva N.P., Pavlenko O.A., Gorelova Y.V., Teteneva A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://bulletin.ssmu.ru/jour/article/view/4920

Беспрецедентные достижения последних десятилетий в области клинической фармакологии, кардиохирургии и имплантационной аритмологии значительно улучшили прогноз у пациентов с хронической сердечной недостаточностью (ХСН), однако, к сожалению, сердечная недостаточность продолжает ассоциироваться с высокой смертностью. Решение этой проблемы видится одновременно в максимально полном применении в клинической практике всех актуальных возможностей непрерывно совершенствующихся методов лечения сердечной недостаточности, доказавших свою эффективность в рандомизированных контролируемых исследованиях (особенно при подтверждении результатами исследований реальной клинической практики), с одной стороны, а также в разработке и оперативном внедрении инновационных подходов к терапии ХСН – с другой. Больше всего в этом нуждаются пациенты с ХСН с умеренно сниженной и сохранной фракцией выброса левого желудочка, бедная доказательная база возможности улучшения прогноза у которых не может обосновывать бездействие и оставление их без надежды хотя бы на клиническое улучшение состояния. В лекции последовательно рассмотрены общие принципы лечения ХСН, комплекс мероприятий, направленный на инотропную стимуляцию и разгрузку (нейрогормональную, объемную, гемодинамическую и иммунную) сердца, а также обозначены некоторые перспективные направления болезнь-модифицирующей терапии.

Unprecedented advances of recent decades in clinical pharmacology, cardiac surgery, arrhythmology, and cardiac pacing have significantly improved the prognosis in patients with chronic heart failure (CHF). However, unfortunately, heart failure continues to be associated with high mortality. The solution to this problem consists in simultaneous comprehensive use in clinical practice of all relevant capabilities of continuously improving methods of heart failure treatment proven to be effective in randomized controlled trials (especially when confirmed by the results of studies in real clinical practice), on the one hand, and in development and implementation of innovative approaches to CHF treatment, on the other hand. This is especially relevant for CHF patients with mildly reduced and preserved left ventricular ejection fraction, as poor evidence base for the possibility of improving the prognosis in such patients cannot justify inaction and leaving them without hope of a clinical improvement in their condition. The lecture consistently covers the general principles of CHF treatment and a set of measures aimed at inotropic stimulation and unloading (neurohormonal, volumetric, hemodynamic, and immune) of the heart and outlines some promising areas of disease-modifying therapy.

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The authors declare that there are no conflicts of interest present.