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2022, vol. 47, br. 1, str. 40-47
Promena paradigme u lečenju hronične srčane insuficijencije po ESC vodiču 2021 - novi inovativni lekovi u fokusu
aInternistička ordinacija "Dr Bastać", Zaječar
bSpecijalistička ordinacija za internu medicinu "Dr Pavlović kardiologija", Beograd
cMedscan Tadić dijagnostika, Zaječar
dZdravstveni centar Zaječar, Zaječar

e-adresadusanbastac@gmail.com
Sažetak
Medicinska, prvenstveno medikamentozna terapija koja je usmerena Novim ESC vodičem odnosno smernicama za pacijente sa srčanom insuficijencijom(HF) donosi značajne novine i promenu paradigme lečenja, od stepenastog uvodjenja lekova prema istovremenom uvodjenju 5 glavnih klasa lekova. Lečenje srčane insuficijencije sa sniženom ejekcionom frakcijom leve komore (HFrEF) i simptomima klase II-Njujorškog udruženja za srce (NYHA)-dispnea pri većem naporu i viših klasa, sada uključuje inhibitor angiotenzinskih receptora neprilizina (ARNI) kao zamenu za inhibitore angiotenzin konvertujuc EG enzima (ACEI). Druga značajna inovacija je dodavanje SGLT-2 inhibitora (SGLT2i = inhibitori kotransportera-2 natrijum-glukoznih kanala); SGLT2i: dapagliflozin ili empagliflozin su sada u prvoj liniji terapije za srčanu insuficijenciju, istovremeno sa uvodjenjem betablokatora (BB), ACEI ili ARNI, inhibitorima mineralokortikotidnih receptora (MRA)i diuretika Henleove petlje pri retenciji tečnosti kao preporuka klase I. U terapiji srčane insuficijencije sa sniženom sniženom ejekcionom frakcijom leve komore (HFrEF) uveden je sakubitril-valsartan, kombinovani inhibitor neprilizina i angiotenzina (ARNI) koji je pokazao dodatno smanjenje KV mortaliteta i hospitalizacija zbog HFrEF u odnosu na ACE inhibitor enalapril. Dapagliflozin i empagliflozin vrše redukciju rizika kardiovaskularnog mortaliteta ili hospitalizacija zbog HF kod bolesnika sa HF i redukovanom ejekcionom frakcijom leve komore <40% (HFrEF) ali je empagliflozin nedavno pokazao efekat i kod HFpEF sa ejekcionom frakcijom od 40% do 65%.
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O članku

jezik rada: srpski, engleski
vrsta rada: pregledni članak
DOI: 10.5937/tmg2201040B
primljen: 17.03.2022.
objavljen onlajn: 19.05.2022.
objavljen u SCIndeksu: 28.05.2022.
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