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ПРИЛОЖЕНИЕ 1
Прогностические факторы при СН
(представлены лишь наиболее изученные факторы)
Демографические характеристики, данные анамнеза и клинического обследования · Пол, возраст, расовая принадлежность, ФК по NYHA, ИМТ, низкая приверженность к лечению · Признаки задержки жидкости, набухание шейных вен, третий тон сердца, низкое САД, повышение ЧСС · Сахарный диабет, почечная недостаточность, депрессия, ХОБЛ, синдром обструктивного апноэ сна, периодическое (волнообразное) дыхание · Ишемическая этиология СН, ранее перенесенный ИМ Стандартные лабораторные анализы · Натрий сыворотки · Ферменты печени, билирубин · Креатинин сыворотки/клиренс креатинина/ расчетная СКФ · Азот мочевины крови/мочи и маркеры повреждения трубочек нефронов · Альбумин сыворотки · Мочевая кислота · Гемоглобин · Гематокрит · Тропонин I/T · Соотношение содержания альбумина и креатинина в моче Нейрогормоны и цитокины1 · Активность ренина плазмы · Ангиотензин II · Альдостерон · Катехоламины · Эндотелин -1 · Адреномодуллин · Натрийуретические гормоны2 · Вазопрессин/Ко-пептин · Провосполительные цитокины · Растворимый ST-2 · Галектин-3 · Маркеры баланса коллагена | Электрофизиологические показатели · Ширина комплекса QRS · Гипертрофия ЛЖ · ФП · Сложные желудочковые аритмии · Вариабельность ритма сердца Показатели визуализирующих методов исследования · Конечно-диастолический размер и фракция укорочения ЛЖ · Кардиоторакальный индекс при рентгенографии грудной клетки · Индекс движения стенок ЛЖ3 · ФВ · Размер левого предсердия · Рестриктивный тип наполнения ЛЖ/короткое время замедления кровотока раннего диастолического наполнения ЛЖ · Функция ПЖ3 · Воспаление (МРТ с контрастированием), содержание железа (МРТ при талассемии) · Амилоидоз (МРТ с контрастированием) · Наличие ишемии и «Уснувшего» миокарда, аритмогенного субстрата Показатели, связанные с пробами с физической нагрузкой (покой/нагрузка) · Максимальное потребление кислорода(VO2; в норме >20мл/кг/мин)4 · Наклон кривой вентиляционного эквивалента/VCO2 · Тест 6-минутной ходьбы(в норме >600м)4 · Сердечный индекс (в норме >2,5л/мин/м2) · Конечно - диастолическое давление в ЛЖ/давление заклинивания легочной артерии ( в норме <12 мм рт. ст.) |
1 – Этот список не полный, и многие другие циркулирующие факторы также могут иметь прогностическое значение.
2 - повышение уровня BNP и NT-proBNP.
3 - нет унифицированных нормативных значений и «точек разделения» для нормы и патологии.
4- переносимость физической нагрузки в значительной степени зависит от уровня тренированности, возраста и пола больного; здесь указаны нормальные значения для лиц моложе 65 лет.
Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр) Журнал Сердечная Недостаточность. 2013; 81(7): 379-472.
ПРИЛОЖЕНИЕ 2
Классификация хронической сердечной недостаточности ОССН (2002г)
Функциональные классы ХСН
I Функциональный класс ХСН – ограничение физической активности отсутствуют: привычная физическая активность не сопровождается быстрой утомляемостью, появлением одышки или сердцебиения. Повышенную нагрузку больной переносит, но она может сопровождаться одышкой и/ или замедленным востановлением сил.
II Функциональный класс ХСН – незначительное ограничение физической активности: в покое симптомы отсутствуют, привычная физическая активность сопровождается утомляемостью, одышкой или сердцебиением.
III Функциональный класс ХСН – заметное ограничение физической активности: в покое симптомы отсутствуют, физическая активность меньшей интенсивности по сравнению с привычными нагрузками сопровождается появлением симптомов.
IV Функциональный класс ХСН – невозможность выполнить какую-либо физическую нагрузку без появлениея дискомфорта; симптомы СН присутствуют в покое и усиливаются при минимальной физической активности.
Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр.) Журнал Сердечная Недостаточность. 2013; 81(7): 379-472.
ПРИЛОЖЕНИЕ 3
Параметры физической активности у больных с различными ФК ХСН
ФК ХСН | Дистанция 6- минутной ходьбы, м |
I | |
II | 301 – 425 |
III | 151 – 300 |
IV | <150 |
Национальные рекомендации ВНОК и ОССН по диагностике и лечению ХСН
(третий пересмотр) Журнал Сердечная Недостаточность. 2009; 2(52):64-106.
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