ESC Guidelines HF Part I Greek

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(ESC) . . . . . ..

(Guidelines and Expert Consensus Documents) , . . . (European Society of Cardiology, ESC), , . , , . ESC (www.escardio.org).

1

, , . , . . (Level of Evidence) (Class of Recommendation) 1 2.

1. / / , IIa IIb / / / / H / / III* / / ,

2. A B C / . .

2

, . European Heart House, ESC. , , , ESC. ESC, . Committee for Practice Guidelines (CPG) ESC (Task Forces, Expert Groups Consensus Panels) . . , . CPG, . , . , . - , , , , . ESC, ESC, . . , . , , . , (surveys and registries),

3

. , . . , .

, () () (). 1995 [1], 1997 [2], 2001 [3], 2005 [4,5]. , , . . , , . , . . , . , . , . ESC 51 , , .

.

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, , . ( ) (Writing Group of the Task Force), CPG. ESC. CPG ( ). , . (evidencebased), . , , , . , .

() 50 . [6] , , . , . [5,7-9] : , , / , , , ( 3). , , , . ,

5

(.. / ). 4. . [10-11] . . , .

3 : (, , , , , , ) (, 3

( , , , )

,

,

, )

6

4 /

, ,

, () , , 40-50%). [17] . , ( ). 40% . , , , 45-50%) 50% . , . [38, 39]

5 ,

11

6 (ACC/AHA) (NYHA) ACC/AHA . , . NYHA

. , B , . , , C . , , D IV . . . 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

7 ( )

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

-, , , , , , (, , ) , -/-, Cushing, , , , , . , . , , , Chagas, HIV , ,

8 , (, (, , ) ,

, , , ,

PCI CABG

13

9

, , , , (, ), , ,

10 Killip . . . , (S3) . . . .

Forrester 1. ( PCWP ) 2. PCWP () 3. PCWP ( ) 4. PCWP ( )

V

. ( 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.

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, , / ,

BNP 2000 pg/ml

1 .

15

11

, / +++ ++ ++ +++

, ++ + +++ ++

++ +++ ++ + +

BNP/NT-proBNP / BNP/NT-proBNP + + + + + + +++ + + +++

+ = , ++ = , +++ = +++ ++ +++ +++ + + ++ +

16

12

, , , -, , , , , , , , , , , LBBB, , , , , , , Lyme , , , / , , , , , , , ICD Echo, , , Echo, Echo/Doppler , , Echo, / Echo CRT-P, CRT-D

/ /

/ Q QRS > 120ms LBBB

17

13

/ , , , , , Echo/Doppler Echo/Doppler ( ) , . , CT, , Echo

Kerley B

18

14

/ARB, , , , , , , AVP, , , , / AR, , , , , , , , , , , - / - , , , GFR , , / AR, pH , Echo ( )

(>150mol/L) (13g/dl 12 ) (150mmol/L) (5.5mmol/L) (>6.5mmol/L) (>500mol/L) BNP >400 pg/ml, NT-proBNP > 2000 pg/ml BNP 10 mg/L,

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15

( 55-60mm) (>45mm) (40mm) (>11-12mm) / ( ) / , , , , , , , ,

,

(>3m/sec) , ,

(2, DT 15) ( 30ms < 30ms > D 2.5 120ms ?

< 35% ?

: CRT-P CRT-D

: , /, LVAD,

: ICD

2 .

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- , , . , . [68] , 18. . heartfailurematters.org ESC, , , . . , . , . [69] , 20-60% . [70-71] European Heart Failure Survey . [72] / .

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. [73] , , , . . [74] . , , . . , C . [75, 76] , . , . , C , . [76] , . [77] , . >2kg 3 , . . , C

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. . IIa, C 1.5-2 L/ , . . [78] IIb, C , . . 10-20 gr / (1-2 ). IIa, C . [79] I, C [ (BMI) > 30kg/m2 ] , . IIa, C , , . ,

.

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. , , , , , . [80] 6 > 6% . [81] . I, C . . . [82, 83] . I, C , . [84] . [85] , , , , , stress. ,

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. [86-90] (rehabilitation) . , I, , , . (, NYHA , KEAK ). . I, , (-), , , . . NYHA III IV. , , , . [91] . 5 (PDE5) (.. ) , . . II, . I, C

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, . . . . (>1500 m) . . , . ( ). . [92] , . I, C (CPAP) , . [93] IIa, C 20% ,

41

. . [94] , . , . IIa, C , . , . .

, ( 19). , . , , , , , . . < 35-40%. , 40 50%. 2

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. , . 191. 2.

3.

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

( 20) 1-2 . 2-4 . . 1 4 . , . , ( 20). 1, 3 6 6 , . ( BUN) . , (NSAID). ,

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. 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 , , - [,

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(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%