medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2021-1-8-16medalphabet-1947Research ArticleКОМОРБИДНЫЕ СОСТОЯНИЯCOMORBIDITYСовременный взгляд на терапию хронической сердечной недостаточности: позиции рекомендаций 2020 года и адъювантная терапияModern view on chronic heart failure therapy: guidelines‑2020 key messages and adjuvant therapyhttps://orcid.org/0000-0001-5801-3742КочетковА. И.KochetkovA. I.

Кочетков Алексей Иванович, к. м. н., доцент кафедры терапии и полиморбидной патологии

Москва

Kochetkov Alexey I.

Moscow

ak_info@list.ruhttps://orcid.org/0000-0002-0795-8225ОстроумоваО. Д.OstroumovaO. D.

Остроумова Ольга Дмитриевна, д. м. н., проф., зав. кафедрой терапии и полиморбидной патологии, проф. кафедры клинической фармакологии и пропедевтики внутренних болезней

Москва

Olga Ostroumova D.

Moscow

ostroumova.olga@mail.ruhttps://orcid.org/0000-0002-2117-5016АраблинскийА. В.ArablinskyA. V.

Араблинский Александр Владимирович, д. м. н., проф., проф. кафедры терапии и полиморбидной патологии, зав. отделением рентгенохирургических методов диагностики и лечения

Москва

Arablinsky Alexander V.

Moscow

alexar-card@mail.ruКовалеваГ. П.KovalevaG. P.

Ковалева Галина Петровна, к. м. н., врач-терапевт

Московская обл., Сергиево-Посадский р-н, пос. Загорские дали

Kovaleva Galina P.

Moscow Region, Sergiev Posad District, Zagorskiye Dali

galinakovaleva678@gmail.comФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияRussian Medical Academy of Continuous Professional EducationRussian FederationФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России; ФГАОУ ВО «Первый Московский государственный медицинский университет имени И. М. Сеченова» Минздрава России (Сеченовский университет)РоссияRussian Medical Academy of Continuous Professional Education; I. M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России; ГБУЗ «Городская клиническая больница имени С. П. Боткина Департамента здравоохранения Москвы»РоссияRussian Medical Academy of Continuous Professional Education; City Clinical Hospital n. a. S. P. BotkinRussian FederationФГБУ «Санаторий „Загорские дали“»Россия‘Zagorskiye Dali’ SanatoriumRussian Federation20210804202101Коморбидные состояния (1)816Copyright © Кочетков А.И., Остроумова О.Д., Араблинский А.В., Ковалева Г.П., 20212021Кочетков А.И., Остроумова О.Д., Араблинский А.В., Ковалева Г.П.Kochetkov A.I., Ostroumova O.D., Arablinsky A.V., Kovaleva G.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/1947

Цель работы. Анализ данных о современных принципах терапии хронической сердечной недостаточности (ХСН) и возможностях адъювантной терапии фосфокреатином.Материалы и методы. Анализ и систематизирование позиций клинических рекомендаций Минздрава Российской Федерации 2020 года по ХСН и современных отечественных и зарубежных литературных данных.Результаты. В настоящее время для терапии ХСН применяется широкий спектр препаратов, способных улучшить прогноз и снизить смертность пациентов с рассматриваемым синдромом, в их числе β-адреноблокаторы, блокаторы ренин-ангиотензин-альдостероновой системы, диуретики, антагонисты альдостерона и ингибиторы неприлизина. Вместе с тем, исходя из особенностей патогенеза ХСН и особенностей энергетического обмена миокарда в условиях сердечной недостаточности, перспективным направлением является использованием дополнительных (адъювантных) препаратов у такой категории пациентов. Здесь особое место занимает фосфоркреатин, который имеет важнейшее значение в поддержании энергетического баланса кардиомиоцитов и широко изучен в большом количестве исследований, подтвердивших его способность не только повышать толерантность к физической нагрузке у больных с ХСН, но и улучшать показатели систолической функции сердца и благоприятно влиять на прогноз, улучшая выживаемость пациентов.Выводы. Исходя из рассмотренной доказательной базы, рациональным подходом в ведении пациентов с ХСН является добавление к стандартной схеме лечении согласно действующим клиническим рекомендациям адъювантной терапии фосфокреатином, что обеспечивает дополнительное улучшение прогноза и снижение показателей смертности больных.

Objective. Data analysis on modern therapy strategies of chronic heart failure (CHF) and the possibilities of adjuvant therapy with phosphocreatine. Methods. Analysis and systematization of the positions of the year 2020 Russian Ministry of Health clinical guidelines on CHF and modern local and international literature data.Results. Currently, for the treatment of CHF, a wide range of drugs are used that can improve the prognosis and reduce mortality in patients, including β-blockers, blockers of the renin-angiotensin-aldosterone system, diuretics, aldosterone antagonists and neprilisin inhibitors. At the same time, based on the peculiarities of the pathogenesis of CHF and the characteristics of the myocardial energy metabolism in heart failure conditions, a promising direction is the use of additional (adjuvant) drugs in this category of patients. Here, a special place is occupied by phosphocreatine, which is essential in maintaining the energy balance of cardiomyocytes and has been widely studied in a large number of studies that have confirmed its ability not only to increase exercise tolerance in patients with CHF, but also to improve heart systolic function and prognosis, improving patient survival. Conclusion. Based on the reviewed body of evidence, a rational approach in the management of patients with CHF is to add adjuvant phosphocreatine therapy to the standard treatment strategy according to the current clinical guidelines, which provides an additional improvement in prognosis and a decrease in mortality rates in patients.

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