Перспективные направления лечения хронической сердечной недостаточности: совершенствование старых или разработка новых?

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.

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