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ESC (www.escardio.org).

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European Heart
House, ESC. ,
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ESC. ESC,
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Committee for Practice Guidelines (CPG) ESC
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1995 [1],
1997 [2], 2001 [3], 2005 [4,5]. ,
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ESC 51
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ACC = American College of Cardiology, AHA = American Heart Association, Hunt SA et. Al. Circulation 2005; 112: 18251852. The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases
th
of the Heart and Great Vessels. 9 ed. Little Brown & Co; 1994. pp 253-256.

12

( )

( , .. )
(HCM), (DCM), (RCM)
(ARVC),

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CABG

13

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10
Killip

Forrester

.

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1.

( PCWP
)
2. PCWP
()
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PCWP ( )
4.
PCWP ( )

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, (S3)
.

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.
(
90mmHg) ,
, .
rd
Killip T, 3 , Kimball JT. Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients.
Am J Cardiol 1967;20:457-464.
Forrester JS, Diamond GA, Swan HJ. Correlative classification of clinical and hemodynamic function after acute myocardial
infarction. Am J Cardiol 1977; 39:137-145.

14

 , , / ,

BNP <100 pg/ml

NT-proBNP <400 pg/ml

BNP 100-400 pg/ml

NT-proBNP 400-2000 pg/ml

BNP > 400 pg/ml

NT-proBNP > 2000 pg/ml

1
.

15

 11

++

++

++

+++

+++

+++

++

++

++

+++

+++

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BNP/NT-proBNP
/
BNP/NT-proBNP

+ = , ++ = , +++ =

16

 12

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CRT-P, CRT-D

17

 13

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)

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Kerley B

Echo/Doppler

18

 14

(>150mol/L)
(13g/dl
12 )

/ARB,
, ,
,
,
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AVP,

GFR

(<135mmol/L)

(>150mmol/L)
(<3.5mmol/L)
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(>500mol/L)
BNP >400 pg/ml,
NT-proBNP > 2000 pg/ml

,
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pH

,

Echo

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(<30g/L)

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)

BNP <100 pg/ml

NT-proBNP <400 pg/ml

INR > 2.5
CRP > 10 mg/L,

19

 15

(<45-50%)

, ,

/
,

(> 55-60mm)

(>45mm)

(<25%)

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)

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20


.

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10%
10% ( 7).
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. [41]

ESC. [41]
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.

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1933, Sir Thomas Lewis

. [43]

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22

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NYHA

.
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1. .
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12).
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23


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24

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25



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Doppler (TDI) Doppler.
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26

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)

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27




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,
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(LBBB).

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Doppler

Doppler

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(<1)

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(8-15)
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Vp

<45cm/s

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>2.5

Valsalva

<2

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28

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29

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30

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31



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32

 17

BNP / NT-

VO2

proBNP

QRS

6-

VE/VCO2

Crea / BUN

(bold)

33

 18

, , ,

34

+ ( ARB)

-

ARB

QRS > 120ms ?

:
CRT-P CRT-D

< 35% ?

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/,
LVAD,

:
ICD

2 .

35

, ,
.
,
. [68]

, 18.

heartfailurematters.org
ESC,
, ,
.

.
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, . [69]
, 20-60%
. [70-71] European Heart Failure
Survey
. [72]

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.

36


. [73]

, ,
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. [74]

.
,

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. [75, 76]

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.

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,
. [76] ,
. [77]

,
. >2kg 3
,
.

.

, C

37

.
.
IIa, C

1.5-2 L/
, .

. [78]
IIb, C

,
.
.

10-20 gr / (1-2
).

IIa, C

. [79]

I, C

[ (BMI) >
30kg/m2 ]
, .
IIa, C
,
,
.

38


.
,
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,
.
[80]

6 > 6%
. [81]
.

I, C

.

.
. [82, 83]

I, C

,
. [84]


. [85] , ,
,

,
,
stress.

,

39

 . [86-90]

(rehabilitation)

I,

, ,
.
(, NYHA ,
KEAK ).
.

I,

,
(-), ,
, .

.
NYHA III IV.
, , ,

. [91]


.

5 (PDE5) (.. )
,
.
.

II,

I, C

40

,
.

.

.


.

(>1500 m)

.
. ,
.


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. [92]

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.

I, C

(CPAP)
,
. [93]

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20%
,

41

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[94]

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.

IIa, C

. ,

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.

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40 50%.
2

42

.
, .
19

1.

2.

3.

()
,
<40%.
,
.
,
.
I,

(CONSENSUS

SOLVD-Treatment)

2800

. [95,96]
, 10%
-. CONSENSUS,
, 53% .

[ (RRR) 27% CONSENSUS
16% SOLVD-Treatment]. SOLVD-Treatment,
RRR 26% .
.

43

(ARR)
(SOLVD-Treatment) 4,5%,
() 22
( 41 ).
(CONSENSUS) ARR = 14,6% = 7 (
6 ), .

,
,
, 3
.
.
[97]

ATLAS, 3164 ,
,
. RRR 15%

.[98]

( 5966
) /
(). [99] SOLVD-Prevention (
4228 ), RRR
20% . ,
(SAVE), (AIRE) (TRACE),
RRR 26% RRR 27%
.
, .

,
, , .

. [99]

44

 ;

:
<40%, .

> 5 mmol/L

> 220mol/L (2,5 mg/dl)

( 20)

1-2
.

2-4 .

. 1
4 .

, .

,

( 20).

1, 3 6
6 , .

(
BUN)

.

(NSAID). ,

45

. 50%
265 mol/L (3 mg/dl),
, .
265 310 mol/L (3 3,5 mg/dl),
.
310 mol/L (3,5 mg/dl),
.

, ..
, ,
. 5,5 mmol/L,
.
6 mmol/L,
.

(.. )
,
.
( ARB / - /
).
.

,
ARB.

-
< 40%
-, . -
,
.
, , -
, .

-
. [100-104]

(CIBIS II, COPERNICUS MERIT-HF)

9000

, - [,

46

 (metoprolol succinate CR)] .

90%
ARB. ,
.

-
(RRR 34% )
(RRR 28-36%),
. , COPERNICUS MERIT-HF,
,
.
, .

ARR ( )
(CIBIS II MERIT-HF) 4,3%, =
23 ( 1 1 ).
(COPERNICUS) ARR = 7,1% NNT=14, .

(SENIORS) 2128 ( 70
), 36% >35%.
RRR = 14%
. [105]

(U.S.

cardedilol

studies),

-
, 1959
40% , RRR ,
, 23% 1,3
. [103]

(BEST) , -,
,
. [106]

, COMET,
(metoprolol
tartrate) [ (succinate CR)
MERIT-HF]. [107]

-
,

47

 (
). , COPERNICUS,
.

,
- .
, .

,
, .

20

(mg)

(mg)

6.25

x3

50-100

x3

2.5

x2

10-20

x2

2.5-5.0

x1

20-35

x1

2.5

x1

x1

0.5

x1

x1

48

x1

32

x1

40

x1

160

x1

25

x1

50

x1

25

x1

25-50

x1

1.25

x1

10

x1

3.125

x2

25-50

x2

12.5/25

x1

200

x1

1.25

x1

10

x1

ARB

48

 -;
,
, :

40%.

( -IV).

-.

/ ARB ( ,
).

. (..
). ,
,
, ,

24 -.

[ ()
].

() 2 3 ,
( ),
(<50bpm).

- ( 20)

: 1.25mg (x1),
3.125-6.25mg (x2), CR/XL 12.5-25mg (x1)
1.25mg (x1) .

-
, ,
.

2-4 (
).

49

 , (.. )
(<50bpm).

,
- ,

10mg (x1), 25-50mg (x2), CR/XL
200mg (x1) 10mg (x1) .

.
( / ARB),
. .

(
) - (
), .

( Holter ,
)

. .
-.

35%

,
IV, .

, ,
.
,
.
I,

50

(RALES)
, .
[108]

RALES, 1663 35% (

IV 6 ),
25-50 ,
, , (95%)
(74%). , -

11% -.

RRR 30%
RRR 35%,
2 .

.
, .

ARR ( 2 )
11,4%, 9 (2
).

(EPHESUS), 6632 , 3-14
, 40% . [109]
25-50
, ,
, /ARB (87%)

- (75%).

RRR 15%.

,
,
, .

.
[110]

/
(10% ,
RALES). , .

51

 ,
/
.
;
,
, :

35%.

( -IV).

- ARB (
ARB).

> 5 mmol/L.

> 220mol/L (2,5 mg/dl).

ARB.

( ) ( 20)
( )

: 25mg (
25mg ).

1 4
.

4-8 .

. 1
4 .

,
50mg
50mg
.

1, 2, 3 6
6 , .

52

5,5 mmol/L,
( ), ..
25mg , .
6 mmol/L, (
) .
.

> 220mol/L (2,5 mg/dl)
( ), .. 25mg ,
. 310 mol/L (3,5
mg/dl), ( )
.
.

/
.

(ARBs)
, ARB
40%,
-,
. ARB

.
I,
.
Ia,

ARBs
. ,
.
, ARB
.

I,

53

(Val-HEFT
CHARM-Added) 7600
ARB ( ) ,
(93% Val-HEFT
CHARM-Added). [111, 112] , 35%
Val-HEFT 55% CHARM-Added , 5% Val-HEFT 17% CHARMAdded .

(RRR 24% Val-HEFT 17% CHARM-Added),
. RRR 16%
CHARMAdded.
, , -.

ARR
4,4%, (
41 ) 23 CHARM-Added.
Val-HEFT ARR=3,3% =30
( 23 ), .

Val-HEFT CHARM
ARB .
.

CHARM-Alternative ,
, , 2028 40%
. [113]
RRR 23%
(ARR = 7%, NNT = 14, 34 ).

ARB
VALLIANT, [114] 14. 703 ,

, .

(non-inferiority)

(OPTIMAAL), . [115, 116]

54

 ARB;

:

<40%

( II IV) .

( II IV)
-.

ARBs ,

. .

, .

ARBs
.

, .

ARBs ( 20)

: 4-8mg
40mg .

1
.

2-4 .

. 1
4 .

,
32mg
160mg
( 20).

55

1, 3 6
6 , .

, .

40%,

ARBs.
(-)
, - ARB
.
.
Ia,
.
Ia,
.
Ia,

(V-HeFT-I A-HeFT) (V-HeFT-)
-. [117-119]

V-HeFT-, 642 ,
-, .
- .
. -

( 2,3 ): RRR 22%, ARR 5,3%, NNT=19.
-
.

56

-HeFT, 1050 , ,
IV, -,
(90%), (60%),
(70%), ARB (17%), - (70%) (39%).
, 10 ,
(RRR 43%, ARR 4%, NNT = 25).
- (RRR
33%) .

V-HeFT-, 804 ,
, -,
.
-.
-, (
2,5 ): 28%.

-
, / .
- 5-10%
V-HeFT ,
() 2-3%
[ (lupus-like syndrome) ].

-;
,
, :

ARBs.

ARB
.

( ).

57

: 37,5 mg 20 mg
.

2-4 .
.

,
75 mg 40 mg
. .

(.. )
.
( /ARB/-/ ).
.

/ , , / ,
,
.

(AF),
. AF 40% ,

-.
I, C
, 40%,
( )
,
, .
Ia,

58

-.

, -,
,
( ) 40%.

( <80 bpm),
( < 110-120 bpm).

40%,

.
, 40%

>

DIG, 6800 45%,

IV,
(0,25mg ),
.
- . [120]

,
RRR = 28% ,
3 . ARR 7,9%, (
3 1 ) 13.

[121],
DIG,

.

,
,
.

59

60