{"id":7340,"date":"2024-08-08T14:38:08","date_gmt":"2024-08-08T06:38:08","guid":{"rendered":"https:\/\/cardiothinklab.com\/strong-hf-rapid-uptitration-of-guideline-directed-medical-therapy-for-heart-failure\/"},"modified":"2025-01-09T11:59:45","modified_gmt":"2025-01-09T03:59:45","slug":"strong-hf-rapid-uptitration-of-guideline-directed-medical-therapy-for-heart-failure","status":"publish","type":"post","link":"https:\/\/cardiothinklab.com\/vi\/strong-hf-rapid-uptitration-of-guideline-directed-medical-therapy-for-heart-failure\/","title":{"rendered":"Nghi\u00ean c\u1ee9u STRONG-HF: T\u0103ng li\u1ec1u Nhanh trong Ph\u00e1c \u0111\u1ed3 theo H\u01b0\u1edbng d\u1eabn \u0111\u1ed1i v\u1edbi Suy tim"},"content":{"rendered":"\r\n
\r\n
Truy c\u1eadp trang Ng\u00e0y Tim m\u1ea1ch Th\u1ebf gi\u1edbi<\/a><\/div>\r\n<\/div>\r\n\r\n\r\n
\r\n
\r\n
\r\n
\r\n
\r\n

T\u00ecnh tr\u1ea1ng sung huy\u1ebft v\u1eabn c\u00f2n \u1edf nhi\u1ec1u b\u1ec7nh nh\u00e2n suy tim c\u1ea5p t\u00ednh khi xu\u1ea5t vi\u1ec7n<\/h4>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n

Ch\u1ee7 \u0111\u1ec1 ch\u00fang ta nghe th\u1ea5y t\u1eeb \u0111\u1ea7u bu\u1ed5i h\u1ecdp l\u00e0 v\u1ec1 suy tim v\u00e0 sung huy\u1ebft. Ch\u00fang ta c\u1ea7n c\u00f3 s\u1ef1 h\u1ee3p t\u00e1c ch\u1eb7t ch\u1ebd h\u01a1n gi\u1eefa Ch\u00e2u \u00c1 v\u00e0 Ch\u00e2u \u00c2u \u0111\u1ec3 c\u1ed1 g\u1eafng x\u00e1c nh\u1eadn k\u1ebft qu\u1ea3 t\u1eeb c\u01a1 s\u1edf d\u1eef li\u1ec7u ESC \u0111\u00e3 \u0111\u01b0\u1ee3c Hi\u1ec7p h\u1ed9i Suy tim ph\u00e2n t\u00edch, cho th\u1ea5y 70% b\u1ec7nh nh\u00e2n b\u1ecb sung huy\u1ebft khi nh\u1eadp vi\u1ec7n. Nh\u01b0ng quan tr\u1ecdng h\u01a1n, v\u00e0 \u0111i\u1ec1u n\u00e0y c\u00f3 l\u1ebd \u0111\u00fang \u1edf b\u1ea5t k\u1ef3 n\u01a1i n\u00e0o tr\u00ean th\u1ebf gi\u1edbi, khi ch\u00fang ta n\u00f3i “T\u1ea1m bi\u1ec7t” v\u1edbi b\u1ec7nh nh\u00e2n b\u1eb1ng c\u00e1ch k\u00fd v\u00e0o b\u00e1o c\u00e1o v\u00e0 n\u00f3i r\u1eb1ng m\u1ecdi th\u1ee9 \u0111\u1ec1u \u1ed5n, r\u1ea5t c\u00f3 th\u1ec3, \u00edt nh\u1ea5t 30 ph\u1ea7n tr\u0103m s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u00f3 v\u1eabn b\u1ecb sung huy\u1ebft khi h\u1ecd tr\u1edf v\u1ec1 nh\u00e0.<\/p>\r\n

Qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n suy tim c\u1ea5p t\u00ednh tr\u01b0\u1edbc v\u00e0 sau khi xu\u1ea5t vi\u1ec7n<\/h4>\r\n

<\/p>\r\n

<\/p>\r\n

V\u1ea5n \u0111\u1ec1 khi \u0111\u00f3 l\u00e0 l\u00e0m th\u1ebf n\u00e0o \u0111\u1ec3 tr\u00e1nh \u0111\u01b0\u1ee3c vi\u1ec7c t\u00e1i nh\u1eadp vi\u1ec7n v\u00ec m\u1ed7i b\u1ec7nh nh\u00e2n suy tim m\u00e0 ph\u1ea3i t\u00e1i nh\u1eadp vi\u1ec7n th\u00ec th\u1eadt l\u00e0 bu\u1ed3n, c\u1ea3m th\u1ea5y lo l\u1eafng v\u00e0 \u0111i\u1ec1u n\u00e0y th\u1ef1c s\u1ef1 l\u00e0m gi\u1ea3m \u0111\u00e1ng k\u1ec3 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng. Khi tham kh\u1ea3o ESC v\u00e0 c\u00e1c h\u01b0\u1edbng d\u1eabn \u1edf B\u1eafc M\u1ef9, ch\u1ec9 th\u1ea5y n\u00f3i m\u1ed9t c\u00e2u: h\u00e3y g\u1eb7p b\u1ec7nh nh\u00e2n c\u1ee7a m\u00ecnh trong v\u00f2ng m\u1ed9t \u0111\u1ebfn hai tu\u1ea7n m\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft ph\u1ea3i n\u00f3i nh\u1eefng g\u00ec ch\u00fang ta n\u00ean l\u00e0m trong l\u1ea7n kh\u00e1m n\u00e0y.<\/p>\r\n

<\/p>\r\n

<\/p>\r\n

C\u00f3 m\u1ed9t ngh\u1ecbch l\u00fd trong b\u1ec7nh suy tim. C\u00f3 m\u1ed9t ph\u1ea7n l\u1edbn ngh\u1ecbch l\u00fd trong suy tim. Hi\u1ec7n nay suy tim \u0111ang gi\u1ebft ch\u1ebft nhi\u1ec1u ng\u01b0\u1eddi h\u01a1n b\u1ea5t k\u1ef3 lo\u1ea1i ung th\u01b0 n\u00e0o. Suy tim \u0111ang gi\u1ebft ch\u1ebft nhi\u1ec1u ng\u01b0\u1eddi h\u01a1n b\u1ea5t k\u1ef3 lo\u1ea1i ung th\u01b0 n\u00e0o c\u1ea3 \u1edf nam v\u00e0 n\u1eef. Trong ngh\u1ecbch l\u00fd n\u00e0y, ch\u00fang ta c\u00f3 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 ch\u1eefa suy tim, \u00edt nh\u1ea5t l\u00e0 \u0111\u1ec3 ph\u00f2ng ng\u1eeba, v\u00e0 ch\u00fang ta \u0111\u00e3 nghe \u0111i\u1ec1u n\u00e0y nhi\u1ec1u l\u1ea7n nh\u01b0ng nhi\u1ec1u ng\u01b0\u1eddi n\u00f3i l\u00e0 \u0111\u1ec3 ng\u0103n ng\u1eeba t\u00e1i nh\u1eadp vi\u1ec7n v\u00e0 \u0111\u00f3 l\u00e0”t\u1ee9 tr\u1ee5”(b\u1ed1n li\u1ec7u ph\u00e1p) \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp nhi\u1ec1u l\u1ea7n. Khi \u0111\u00f3, suy tim c\u00f2n gi\u1ebft ch\u1ebft nhi\u1ec1u ng\u01b0\u1eddi h\u01a1n c\u1ea3 ung th\u01b0. Ch\u00fang t\u00f4i c\u00f3 ho\u00e1 tr\u1ecb li\u1ec7u \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb suy tim.<\/p>\r\n

Kho\u1ea3ng c\u00e1ch l\u1edbn v\u1ec1 Ph\u00e1c \u0111\u1ed3 theo H\u01b0\u1edbng d\u1eabn gi\u1eefa c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n<\/h4>\r\n

Tuy nhi\u00ean, ch\u00fang t\u00f4i kh\u00f4ng d\u00f9ng thu\u1ed1c \u0111\u1ec3 ch\u1eefa kh\u1ecfi suy tim, v\u00e0 ch\u00fang t\u00f4i bi\u1ebft r\u1eb1ng tr\u00ean to\u00e0n th\u1ebf gi\u1edbi v\u00e0 c\u00f3 l\u1ebd kh\u00f4ng c\u00f3 ngo\u1ea1i l\u1ec7.T\u1ee9 tr\u1ee5 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng d\u01b0\u1edbi 25% th\u1eddi gian. V\u00e0 li\u1ec7u r\u1eb1ng ho\u00e1 tr\u1ecb li\u1ec7u \u0111\u00e3 ho\u00e0n t\u1ea5t hay ch\u01b0a n\u1ebfu ch\u00fang ta cho d\u00f9ng \u0111\u1ee7 li\u1ec1u ho\u00e1 tr\u1ecb cho b\u1ec7nh suy tim, v\u00e0 ch\u1ec9 1-2% s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7y \u0111\u1ee7.<\/p>\r\n

Nghi\u00ean c\u1ee9u STRONG-HF<\/h4>\r\n

<\/p>\r\n

<\/p>\r\n

Nghi\u00ean c\u1ee9u STRONG-HF \u0111\u00e1ng ng\u1ea1c nhi\u00ean \u0111\u00e3 \u0111\u1ebfn Ch\u00e2u \u00c1 v\u00e0 n\u00f3 \u0111\u1ebfn t\u1eeb nghi\u00ean c\u1ee9u n\u00e0y, \u1edf \u0111\u00e2y, n\u01a1i qu\u00fd v\u1ecb c\u00f3 th\u1ec3 nh\u1eadn ra \u0111\u1ed3ng t\u00e1c gi\u1ea3 t\u1eeb nhi\u1ec1u n\u01b0\u1edbc ch\u00e2u \u00c1. V\u00e0 tr\u00ean th\u1ef1c t\u1ebf, ch\u00fang t\u00f4i \u0111\u00e3 ti\u1ebfn h\u00e0nh nghi\u00ean c\u1ee9u tr\u00ean m\u1ed9t nh\u00f3m thu\u1ea7n t\u1eadp l\u1edbn g\u1ed3m 20 ngh\u00ecn b\u1ec7nh nh\u00e2n suy tim c\u1ea5p t\u00ednh t\u1eeb c\u1ea3 ch\u00e2u \u00c2u v\u00e0 ch\u00e2u \u00c1, nh\u1eefng qu\u1ed1c gia kh\u00e1c nhau \u1edf ch\u00e2u \u00c1. Ch\u00fang t\u00f4i theo d\u00f5i h\u1ecd trong m\u1ed9t n\u0103m sau giai \u0111o\u1ea1n suy tim c\u1ea5p t\u00ednh. Th\u1ef1c t\u1ebf cho th\u1ea5y khi thu\u1ed1c ch\u1eb9n beta v\u00e0 RASi \u0111\u01b0\u1ee3c d\u00f9ng k\u1ebft h\u1ee3p \u1edf b\u1ec7nh nh\u00e2n, kh\u1ea3 n\u0103ng s\u1ed1ng s\u00f3t t\u1ed1t h\u01a1n nhi\u1ec1u so v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb.<\/p>\r\n

\r\n
\r\n
T\u00ecm hi\u1ec3u th\u00eam trong bi\u1ec3u \u0111\u1ed3 th\u00f4ng tin v\u1ec1 k\u1ebft qu\u1ea3 ch\u00ednh c\u1ee7a nghi\u00ean c\u1ee9u STRONG-HF<\/a><\/div>\r\n<\/div>\r\n<\/div>\r\n
Ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 ch\u00ednh<\/h5>\r\n

<\/p>\r\n

<\/p>\r\n

Ngay l\u1eadp t\u1ee9c, \u0111\u00e2y l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a nghi\u00ean c\u1ee9u STRONG. Qu\u00fd v\u1ecb s\u1ebd th\u1ea5y k\u1ebft qu\u1ea3 y h\u1ec7t nh\u01b0 th\u1ebf. Th\u1ef1c t\u1ebf l\u00e0, ch\u00fang t\u00f4i \u0111\u00e3 l\u1eb7p l\u1ea1i nh\u1eefng g\u00ec ch\u00fang t\u00f4i \u0111\u00e3 l\u00e0m nhi\u1ec1u n\u0103m tr\u01b0\u1edbc. \u0110\u00e2y l\u00e0 n\u01a1i c\u00f3 nhi\u1ec1u qu\u1ed1c gia Ch\u00e2u \u00c1. \u1ede \u0111\u00e2y, ch\u00fang t\u00f4i \u0111\u00e3 d\u00f9ng thu\u1ed1c ch\u1eb9n beta, RASi v\u00e0 MRA li\u1ec1u cao \u0111\u1ea7y \u0111\u1ee7 v\u00e0 ch\u00fang t\u00f4i c\u00f3 th\u1ec3 l\u1eb7p l\u1ea1i ch\u00ednh x\u00e1c nh\u1eefng k\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 c\u0169ng nh\u01b0 c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng t\u00e1i nh\u1eadp vi\u1ec7n v\u00e0 t\u1eed vong do suy tim.<\/p>\r\n

Thi\u1ebft k\u1ebf nghi\u00ean c\u1ee9u<\/h5>\r\n

Ch\u00fang t\u00f4i \u0111\u00e3 l\u00e0m \u0111i\u1ec1u n\u00e0y nh\u01b0 th\u1ebf n\u00e0o? Thi\u1ebft k\u1ebf nghi\u00ean c\u1ee9u kh\u00e1 \u0111\u01a1n gi\u1ea3n. B\u1ec7nh nh\u00e2n s\u1eafp \u0111\u01b0\u1ee3c xu\u1ea5t vi\u1ec7n sau suy tim c\u1ea5p t\u00ednh \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o m\u1ed9t nh\u00e1nh. C\u00e1c b\u00e1c s\u0129 tim m\u1ea1ch trong th\u00e0nh ph\u1ed1 theo d\u00f5i b\u1ec7nh nh\u00e2n v\u00e0 \u1edf nh\u00e1nh kia ch\u00fang t\u00f4i \u0111\u00e3 cung c\u1ea5p tr\u01b0\u1edbc khi xu\u1ea5t vi\u1ec7n. \u0110i\u1ec1u n\u00e0y r\u1ea5t quan tr\u1ecdng. Tr\u01b0\u1edbc khi xu\u1ea5t vi\u1ec7n, ch\u00fang t\u00f4i cho d\u00f9ng m\u1ed9t n\u1eeda li\u1ec1u t\u1ed1i \u01b0u c\u1ee7a thu\u1ed1c ch\u1eb9n beta. Ngo\u00e0i ra, c\u00f9ng l\u00fac \u0111\u00f3, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c cho d\u00f9ng m\u1ed9t n\u1eeda li\u1ec1u t\u1ed1i \u01b0u RASi v\u00e0 m\u1ed9t n\u1eeda li\u1ec1u t\u1ed1i \u01b0u MRA. M\u1ed9t tu\u1ea7n sau, ch\u00fang t\u00f4i \u0111\u1ec1 ngh\u1ecb b\u1ec7nh nh\u00e2n quay l\u1ea1i \u0111\u1ec3 ki\u1ec3m tra xem k\u1ebft h\u1ee3p ba lo\u1ea1i thu\u1ed1c \u0111\u00f3 c\u00f3 an to\u00e0n kh\u00f4ng v\u00e0 t\u00f4i s\u1ebd cho qu\u00fd v\u1ecb th\u1ea5y c\u00e1ch ch\u00fang t\u00f4i \u0111\u00e3 l\u00e0m. V\u00e0o tu\u1ea7n th\u1ee9 hai, ch\u00fang t\u00f4i \u0111\u1ec1 ngh\u1ecb c\u00e1c b\u00e1c s\u0129 tim m\u1ea1ch b\u1ea5t ch\u1ea5p m\u1ecdi l\u00fd do kh\u00e1c \u0111\u1ec3 t\u0103ng li\u1ec1u l\u01b0\u1ee3ng ba lo\u1ea1i thu\u1ed1c l\u00ean m\u1ee9c t\u1ed1i \u0111a, tr\u1eeb khi c\u00f3 v\u1ea5n \u0111\u1ec1 v\u1ec1 an to\u00e0n. T\u00f4i s\u1ebd tr\u1edf l\u1ea1i trong m\u1ed9t ph\u00fat \u0111\u1ec3 cho qu\u00fd v\u1ecb bi\u1ebft v\u1ec1 v\u1ea5n \u0111\u1ec1 an to\u00e0n. Sau \u0111\u00f3 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c theo d\u00f5i trong nh\u1eefng tu\u1ea7n ti\u1ebfp theo v\u00e0 ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 ch\u00ednh l\u00e0 180 ng\u00e0y.<\/p>\r\n

\u0110\u00e1nh gi\u00e1 chung v\u1ec1 t\u00ecnh tr\u1ea1ng sung huy\u1ebft<\/h5>\r\n

<\/p>\r\n

Ch\u00fang t\u00f4i \u0111\u00e3 l\u00e0m g\u00ec khi th\u0103m kh\u00e1m? C\u00e1c h\u01b0\u1edbng d\u1eabn \u1edf c\u1ea3 M\u1ef9 v\u00e0 ch\u00e2u \u00c2u n\u00f3i r\u1eb1ng, qu\u00fd v\u1ecb c\u1ea7n ph\u1ea3i th\u0103m kh\u00e1m b\u1ec7nh nh\u00e2n, nh\u01b0ng h\u1ecd kh\u00f4ng n\u00f3i c\u1ea7n ph\u1ea3i l\u00e0m g\u00ec khi th\u0103m kh\u00e1m. V\u00e0 tr\u00ean th\u1ef1c t\u1ebf, ch\u00fang t\u00f4i \u0111\u00e3 c\u00f3 m\u1ed9t quy tr\u00ecnh r\u1ea5t nghi\u00eam ng\u1eb7t trong nghi\u00ean c\u1ee9u STRONG. Ch\u00fang t\u00f4i y\u00eau c\u1ea7u t\u1ea5t c\u1ea3 c\u00e1c b\u00e1c s\u0129 theo d\u00f5i c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng: m\u1ec7t m\u1ecfi, kh\u00f3 th\u1edf, ph\u00f9, t\u0103ng c\u00e2n, nh\u1ecbp tim, huy\u1ebft \u00e1p v\u00e0 ch\u00fang t\u00f4i y\u00eau c\u1ea7u th\u1ef1c hi\u1ec7n x\u00e9t nghi\u1ec7m sinh h\u1ecdc t\u1ea1i m\u1ed7i l\u1ea7n kh\u00e1m. Natriuretic peptide l\u00e0 th\u00f4ng s\u1ed1 ch\u00ednh nh\u01b0ng kali, creatinin c\u0169ng r\u1ea5t quan tr\u1ecdng v\u00e0 hematocrite c\u0169ng v\u1eady.<\/p>\r\n

X\u00e9t nghi\u1ec7m NT-proBNP c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 theo d\u00f5i b\u1ec7nh nh\u00e2n t\u0103ng li\u1ec1u trong Ph\u00e1c \u0111\u1ed3 theo H\u01b0\u1edbng d\u1eabn<\/h5>\r\n

<\/p>\r\n

<\/p>\r\n

Qu\u00fd v\u1ecb s\u1ebd th\u1ea5y r\u1eb1ng ch\u00fang t\u00f4i kh\u00f4ng ti\u1ebfn h\u00e0nh nh\u1eefng quy tr\u00ecnh ph\u1ee9c t\u1ea1p trong nghi\u00ean c\u1ee9u STRONG. Ch\u00fang t\u00f4i \u0111\u00e3 l\u00e0m ch\u00ednh x\u00e1c nh\u1eefng g\u00ec qu\u00fd v\u1ecb \u0111ang l\u00e0m trong c\u00f4ng vi\u1ec7c c\u1ee7a m\u00ecnh, nh\u01b0ng ch\u00fang t\u00f4i k\u1ebft h\u1ee3p t\u1ea5t c\u1ea3 l\u1ea1i v\u1edbi nhau. Ch\u00fang t\u00f4i \u0111\u00e3 n\u00f3i n\u1ebfu NT-proBNP t\u0103ng nhi\u1ec1u h\u01a1n so v\u1edbi khi b\u1ec7nh nh\u00e2n xu\u1ea5t vi\u1ec7n, h\u00e3y t\u0103ng li\u1ec1u thu\u1ed1c l\u1ee3i ti\u1ec3u quai, \u0111\u00e8n xanh l\u00e1. N\u1ebfu NT-proBNP gi\u1ea3m, khi \u0111\u00f3 s\u1ebd ng\u1eebng t\u0103ng li\u1ec1u. \u0110\u1ed1i v\u1edbi thu\u1ed1c ch\u1eb9n beta, n\u1ebfu NT-proBNP gi\u1ea3m, nh\u1ecbp tim \u1ed5n \u0111\u1ecbnh, huy\u1ebft \u00e1p t\u00e2m thu \u1ed5n \u0111\u1ecbnh, qu\u00fd v\u1ecb s\u1ebd t\u0103ng li\u1ec1u l\u00ean m\u1ee9c t\u1ed1i \u0111a v\u00e0o tu\u1ea7n th\u1ee9 hai v\u00e0 c\u0169ng t\u01b0\u01a1ng t\u1ef1 \u0111\u1ed1i v\u1edbi thu\u1ed1c ACEi. Tuy nhi\u00ean, trong r\u1ea5t \u00edt tr\u01b0\u1eddng h\u1ee3p, khi ch\u00fang t\u00f4i th\u1ea5y NT-proBNP t\u0103ng l\u00ean, c\u00f3 t\u00ecnh tr\u1ea1ng t\u0103ng huy\u1ebft \u00e1p nghi\u00eam tr\u1ecdng, th\u00ec khi \u0111\u00f3 ch\u00fang t\u00f4i s\u1ebd ng\u1eebng t\u0103ng li\u1ec1u v\u00e0 \u0111\u00e2y ch\u00ednh x\u00e1c l\u00e0 nh\u1eefng g\u00ec ch\u00fang t\u00f4i \u0111\u00e3 l\u00e0m \u1edf \u0111\u00e2y.<\/p>\r\n

V\u00e0 trong h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p, NT-proBNP \u0111\u1ec1u \u1ed5n \u0111\u1ecbnh, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c nh\u1eadp vi\u1ec7n, \u1edf \u0111\u00e2y \u00f4 m\u00e0u xanh d\u01b0\u01a1ng l\u00e0 b\u1ec7nh vi\u1ec7n. Tr\u01b0\u1edbc khi xu\u1ea5t vi\u1ec7n, qu\u00fd v\u1ecb th\u1ea5y k\u1ebft qu\u1ea3 NT-proBNP m\u00e0u xanh l\u00e1 \u0111ang gi\u1ea3m xu\u1ed1ng v\u00e0 sau \u0111\u00f3 ch\u00fang t\u00f4i \u0111\u00e3 d\u00f9ng m\u1ed9t n\u1eeda li\u1ec1u l\u01b0\u1ee3ng c\u1ee7a ba lo\u1ea1i thu\u1ed1c. Sang tu\u1ea7n th\u1ee9 hai, NT-proBNP v\u1eabn gi\u1ea3m. \u0110\u00e2y l\u00e0 \u0111a s\u1ed1 v\u00e0 khi ch\u00fang t\u00f4i \u0111\u00e3 cho d\u00f9ng li\u1ec1u \u0111\u1ea7y \u0111\u1ee7 c\u1ee7a Ph\u00e1c \u0111\u1ed3 theo H\u01b0\u1edbng d\u1eabn. Trong m\u1ed9t s\u1ed1 \u00edt tr\u01b0\u1eddng h\u1ee3p, NT-proBNP sau khi xu\u1ea5t vi\u1ec7n v\u00e0 sau khi k\u1ebft h\u1ee3p ba lo\u1ea1i thu\u1ed1c v\u1edbi m\u1ed9t n\u1eeda li\u1ec1u, NT-proBNP t\u0103ng l\u00ean. Khi, ch\u00fang t\u00f4i \u0111\u00e3 h\u1ecfi nghi\u00ean c\u1ee9u vi\u00ean v\u00e0 ch\u00fang t\u00f4i h\u1ecfi qu\u00fd v\u1ecb, r\u1eb1ng qu\u00fd v\u1ecb c\u00f3 tu\u00e2n th\u1ee7 quy tr\u00ecnh STRONG hay kh\u00f4ng. N\u1ebfu qu\u00fd v\u1ecb th\u1ea5y NT-proBNP \u0111ang t\u0103ng th\u00ec \u0111i\u1ec1u \u0111\u00f3 r\u1ea5t d\u1ec5 hi\u1ec3u. Ch\u00fang t\u00f4i \u0111\u00e3 n\u00f3i \u0111i\u1ec1u n\u00e0y t\u1eeb tr\u01b0\u1edbc. Qu\u00fd v\u1ecb ch\u1ec9 c\u1ea7n t\u0103ng li\u1ec1u thu\u1ed1c l\u1ee3i ti\u1ec3u \u0111\u1ec3 gi\u1ea3m sung huy\u1ebft cho b\u1ec7nh nh\u00e2n. Qu\u00fd v\u1ecb \u0111\u1ee3i m\u1ed9t \u0111\u1ebfn hai tu\u1ea7n. Qu\u00fd v\u1ecb th\u1ea5y NT-proBNP \u0111ang gi\u1ea3m v\u00e0 khi \u0111\u00f3 qu\u00fd v\u1ecb ch\u1ec9 c\u1ea7n t\u0103ng l\u00ean li\u1ec1u \u0111\u1ea9y \u0111\u1ee7 c\u1ee7a t\u1ea5t c\u1ea3 c\u00e1c lo\u1ea1i thu\u1ed1c. Ch\u00fang t\u00f4i \u0111\u00e3 th\u00e0nh c\u00f4ng khi m\u1ed9t n\u1eeda s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ea7y \u0111\u1ee7 li\u1ec1u thu\u1ed1c ch\u1eb9n beta v\u00e0 \u0111\u1ea7y \u0111\u1ee7 li\u1ec1u RASi, th\u1eadm ch\u00ed 80 ph\u1ea7n tr\u0103m s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ea7y \u0111\u1ee7 li\u1ec1u MRA.<\/p>\r\n

C\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng sung huy\u1ebft<\/h5>\r\n

<\/p>\r\n

<\/p>\r\n

\u0110\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng k\u1ebft qu\u1ea3 \u0111\u00e1ng kinh ng\u1ea1c v\u1edbi nghi\u00ean c\u1ee9u STRONG. Thu\u1ed1c u\u1ed1ng, k\u1ebft h\u1ee3p ba lo\u1ea1i thu\u1ed1c u\u1ed1ng, m\u1eb7c d\u00f9 li\u1ec1u thu\u1ed1c l\u1ee3i ti\u1ec3u th\u1ea5p h\u01a1n so v\u1edbi ch\u0103m s\u00f3c th\u00f4ng th\u01b0\u1eddng, \u0111\u00e3 \u0111\u1ea1t \u0111\u01b0\u1ee3c k\u1ebft qu\u1ea3 \u0111\u00e1ng kinh ng\u1ea1c trong sung huy\u1ebft. V\u00e0 qu\u00fd v\u1ecb c\u00f3 th\u1ec3 th\u1ea5y \u1edf \u0111\u00e2y t\u1ea5t c\u1ea3 c\u00e1c th\u00f4ng s\u1ed1 m\u00e0 ai c\u0169ng mong mu\u1ed1n \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n, ch\u00fang \u0111\u00e3 \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n, ch\u1ec9 v\u00ec ch\u00fang t\u00f4i \u0111\u01b0a ra ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 ch\u00ednh v\u1ec1 thu\u1ed1c \u0111\u1ea7y \u0111\u1ee7 nh\u01b0 t\u00f4i \u0111\u00e3 tr\u00ecnh b\u00e0y tr\u01b0\u1edbc \u0111\u00f3 l\u00e0 t\u00edch c\u1ef1c, ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u0169ng \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n, t\u1ef7 l\u1ec7 t\u1eed vong c\u0169ng t\u1ed1t h\u01a1n v\u1ec1 m\u1eb7t s\u1ed1 li\u1ec7u v\u00e0 t\u1ea5t c\u1ea3 c\u00e1c th\u00f4ng s\u1ed1 \u0111\u00f3 \u0111\u1ec1u \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n nhi\u1ec1u h\u01a1n n\u1eefa, s\u1ef1 kh\u00e1c bi\u1ec7t s\u1ebd l\u1edbn h\u01a1n nhi\u1ec1u n\u1ebfu ch\u00fang ta lo\u1ea1i b\u1ecf nh\u1eefng b\u1ec7nh nh\u00e2n t\u1eed vong v\u00ec Covid.<\/p>\r\n

Li\u1ec7u ph\u00e1p th\u1ee9 nh\u1ea5t sau su\u1ea5t vi\u1ec7n cho suy tim c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n (HFpEF)<\/h5>\r\n

<\/p>\r\n

<\/p>\r\n

M\u1ed9t c\u00e2u h\u1ecfi m\u00e0 t\u00f4i th\u01b0\u1eddng th\u1eafc m\u1eafc k\u1ec3 t\u1eeb khi b\u00e1o c\u00e1o n\u00e0y ra \u0111\u1eddi v\u00e0 b\u00e1o c\u00e1o tuy\u1ec7t v\u1eddi c\u1ee7a Matteo Pagnesi ra \u0111\u1eddi c\u00e1ch \u0111\u00e2y v\u00e0i tu\u1ea7n l\u00e0 li\u1ec7u n\u00f3 c\u00f3 hi\u1ec7u qu\u1ea3 v\u1edbi suy tim c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n (HFpEF) kh\u00f4ng? \u0110\u00e2y l\u00e0 m\u1ed9t b\u1ea5t ng\u1edd l\u1edbn trong nghi\u00ean c\u1ee9u STRONG. K\u1ebft qu\u1ea3 \u0111\u1ea1t \u0111\u01b0\u1ee3c t\u1ed1t h\u01a1n m\u1ed9t ch\u00fat v\u00e0 th\u1ef1c s\u1ef1 c\u00f3 hi\u1ec7u qu\u1ea3 \u1edf c\u1ea3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n. Nh\u01b0ng \u1edf \u0111\u00e2y ch\u00fang t\u00f4i c\u00f3 c\u1ea3m gi\u00e1c r\u1eb1ng n\u00f3 th\u1eadm ch\u00ed c\u00f2n t\u1ed1t h\u01a1n \u0111\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n v\u00e0 Matteo \u0111\u00e3 th\u1ec3 hi\u1ec7n \u1edf \u0111\u00e2y tr\u00ean tr\u1ee5c x, qu\u00fd v\u1ecb th\u1ea5y t\u1ea5t c\u1ea3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i ban \u0111\u1ea7u. V\u00e0 qu\u00fd v\u1ecb th\u1ea5y r\u1eb1ng t\u00e1c \u0111\u1ed9ng t\u00edch c\u1ef1c c\u1ee7a STRONG lu\u00f4n \u0111\u00fang v\u00e0 \u0111i\u1ec1u n\u00e0y r\u1ea5t t\u1ed1t, t\u1ea1i sao? B\u1edfi v\u00ec ch\u00fang ta v\u1eeba nghe Gi\u00e1o s\u01b0 Rozano n\u00f3i c\u00e2u \u0111\u00f3 m\u1ed9t ph\u00fat tr\u01b0\u1edbc \u0111\u00e2y. C\u00e1c thu\u1ed1c d\u00f9ng cho suy tim c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n (HFpEF) v\u1eeba ra m\u1eaft. Ch\u00fang t\u00f4i v\u1eeba c\u00f3 m\u1ed9t khuy\u1ebfn c\u00e1o m\u1edbi v\u1ec1 suy tim c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n (HFpEF), v\u00e0 trong nghi\u00ean c\u1ee9u STRONG l\u1ea7n \u0111\u1ea7u ti\u00ean ch\u00fang t\u00f4i n\u00f3i t\u1edbi t\u00ecnh tr\u1ea1ng m\u1ea5t b\u00f9 c\u1ea5p t\u00ednh v\u00e0 b\u1ec7nh nh\u00e2n b\u1ecb suy tim c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n (HFpEF), ch\u00fang t\u00f4i c\u00f3 m\u1ed9t gi\u1ea3i ph\u00e1p. Trong nhi\u1ec1u n\u0103m, t\u00f4i \u0111\u00e3 ph\u1ea3i kh\u00f3c khi cho b\u1ec7nh nh\u00e2n v\u1ec1 nh\u00e0 m\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng b\u1ea5t k\u1ef3 lo\u1ea1i thu\u1ed1c n\u00e0o v\u00ec h\u1ecd \u0111ang b\u1ecb suy tim m\u1ea5t b\u00f9. V\u00e0 \u0111\u00e2y l\u00e0 l\u1ea7n \u0111\u1ea7u ti\u00ean, \u00edt nh\u1ea5t l\u00e0 trong s\u00e1u th\u00e1ng \u0111\u1ea7u ti\u00ean, ch\u00fang t\u00f4i c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb cho h\u1ecd v\u00e0 t\u00ecnh h\u00ecnh c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n.<\/p>\r\n

<\/p>\r\n

<\/p>\r\n

M\u1ed9t c\u00e2u h\u1ecfi kh\u00e1c m\u00e0 t\u00f4i th\u01b0\u1eddng th\u1eafc m\u1eafc l\u00e0 tu\u1ed5i t\u00e1c. Nh\u01b0 qu\u00fd v\u1ecb th\u1ea5y \u1edf \u0111\u00e2y, kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 tu\u1ed5i t\u00e1c. S\u1ef1 th\u1eadt l\u00e0 nghi\u00ean c\u1ee9u STRONG \u0111\u00e3 c\u00f3 \u0111\u01b0\u1ee3c k\u1ebft qu\u1ea3 t\u00edch c\u1ef1c.<\/p>\r\n

\u0110\u00e2y l\u00e0 b\u00e1o c\u00e1o c\u1ee7a Mattia Arrigo tr\u00ean T\u1ea1p ch\u00ed Suy tim c\u1ee7a Ch\u00e2u \u00c2u. Th\u1eadt v\u1eady, ch\u00fang t\u00f4i th\u1ea5y t\u1ef7 l\u1ec7 t\u00e1c d\u1ee5ng ngo\u1ea1i \u00fd cao h\u01a1n m\u1ed9t ch\u00fat nh\u01b0ng kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i nghi\u00eam tr\u1ecdng ho\u1eb7c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i nghi\u00eam tr\u1ecdng g\u00e2y t\u1eed vong. Trong nghi\u00ean c\u1ee9u STRONG, khi ch\u00fang t\u00f4i b\u1eaft \u0111\u1ea7u nghi\u00ean c\u1ee9u, ch\u1ec9 c\u00f3 thu\u1ed1c ch\u1eb9n beta, ARNi, RASi v\u00e0 MRA \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh, sau \u0111\u00f3 ch\u00fang t\u00f4i th\u00fac \u0111\u1ea9y \u0111\u1ec3 cung c\u1ea5p \u0111\u1ea7y \u0111\u1ee7 ba lo\u1ea1i thu\u1ed1c n\u00e0y cho b\u1ec7nh nh\u00e2n trong v\u00f2ng hai tu\u1ea7n sau khi xu\u1ea5t vi\u1ec7n. Th\u1ef1c t\u1ebf trong l\u00fac \u0111\u00f3, glyffozin \u0111\u00e3 ra \u0111\u1eddi. Nghi\u00ean c\u1ee9u c\u00f3 \u0111\u1ed9ng l\u1ef1c v\u1edbi k\u1ebft qu\u1ea3 t\u00edch c\u1ef1c. R\u1ea5t c\u00f3 th\u1ec3 n\u1ebfu th\u1ef1c s\u1ef1 ph\u1ea3i l\u00e0m l\u1ea1i, qu\u00fd v\u1ecb s\u1ebd th\u1ef1c hi\u1ec7n c\u1ea3 b\u1ed1n li\u1ec7u ph\u00e1p v\u00e0 r\u1ea5t c\u00f3 th\u1ec3 k\u1ebft qu\u1ea3 s\u1ebd t\u1ed1t nh\u01b0 v\u1eady, th\u1eadm ch\u00ed c\u00f3 th\u1ec3 t\u1ed1t h\u01a1n so v\u1edbi nghi\u00ean c\u1ee9u STRONG hi\u1ec7n t\u1ea1i c\u00f3 th\u1ec3 th\u1ea5y v\u1edbi b\u1ed1n lo\u1ea1i thu\u1ed1c.<\/p>\r\n

\u0110\u00e1nh gi\u00e1 v\u1ec1 vi\u1ec7c qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n suy tim c\u1ea5p t\u00ednh<\/h4>\r\n

\u0110\u00e2y l\u00e0 l\u1ea7n \u0111\u1ea7u ti\u00ean t\u00f4i tr\u00ecnh b\u00e0y s\u1ed1 li\u1ec7u n\u00e0y trong b\u00e0i \u0111\u00e1nh gi\u00e1 s\u1ebd \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 trong cu\u1ed9c h\u1ecdp ESC t\u1ea1i Amsterdam trong v\u00e0i tu\u1ea7n t\u1edbi. C\u00f9ng v\u1edbi cu\u1ed9c h\u1ecdp, qu\u00fd v\u1ecb s\u1ebd th\u1ea5y \u0111\u00e1nh gi\u00e1 h\u1eefu \u00edch v\u1ec1 b\u1ec7nh suy tim c\u1ea5p \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 tr\u00ean T\u1ea1p ch\u00ed Tim m\u1ea1ch Ch\u00e2u \u00c2u. V\u1edbi h\u00ecnh \u1ea3nh n\u00e0y ch\u00fang ta th\u1ea5y khi nh\u1eadp vi\u1ec7n v\u1edbi t\u00ecnh tr\u1ea1ng suy tim c\u1ea5p, ch\u00fang ta n\u00ean \u0111i\u1ec1u tr\u1ecb nh\u01b0 th\u1ebf n\u00e0o trong ng\u00e0y \u0111\u1ea7u ti\u00ean. \u1ede \u0111\u00e2y, c\u00f3 m\u1ed9t b\u1ec7nh nh\u00e2n xu\u1ea5t vi\u1ec7n v\u00e0 qu\u00fd v\u1ecb th\u1ea5y h\u00ecnh m\u00e0u tr\u1eafng, c\u00e1c thu\u1ed1c d\u1ea1ng u\u1ed1ng d\u00f9ng cho tim, n\u00ean b\u1eaft \u0111\u1ea7u d\u00f9ng m\u1ed9t n\u1eeda li\u1ec1u tr\u01b0\u1edbc khi xu\u1ea5t vi\u1ec7n v\u00e0 ch\u00fang ta \u0111\u1eebng qu\u00ean ki\u1ec3m tra l\u1ea1i t\u00ecnh tr\u1ea1ng sung huy\u1ebft c\u1ee7a b\u1ec7nh nh\u00e2n. H\u00e3y xem nh\u1eefng g\u00ec ch\u00fang t\u00f4i \u0111ang l\u00e0m b\u1eb1ng c\u00e1ch cung c\u1ea5p li\u1ec7u ph\u00e1p \u0111\u1ea7y \u0111\u1ee7 an to\u00e0n, bao g\u1ed3m c\u1ea3 x\u00e9t nghi\u1ec7m sinh h\u1ecdc v\u00e0 x\u00e9t nghi\u1ec7m l\u00e2m s\u00e0ng. V\u00e0 n\u1ebfu m\u1ecdi vi\u1ec7c di\u1ec5n ra t\u1ed1t \u0111\u1eb9p, qu\u00fd v\u1ecb c\u00f3 th\u1ec3 leo n\u00fai, c\u00f3 th\u1ec3 l\u00e0 Fujiyama, nh\u01b0ng kh\u00f4ng c\u00f3 nhi\u1ec1u \u1edf Singapore.<\/p>\r\n

\r\n
\u00a0<\/div>\r\n<\/div>\r\n

<\/p>\r\n\r\n\r\n

\r\n
Truy c\u1eadp trang Ng\u00e0y Tim m\u1ea1ch Th\u1ebf gi\u1edbi<\/a><\/div>\r\n<\/div>\r\n","protected":false},"excerpt":{"rendered":"

T\u00ecnh tr\u1ea1ng sung huy\u1ebft v\u1eabn c\u00f2n \u1edf nhi\u1ec1u b\u1ec7nh nh\u00e2n suy tim c\u1ea5p t\u00ednh khi xu\u1ea5t vi\u1ec7n Ch\u1ee7 \u0111\u1ec1 ch\u00fang ta nghe th\u1ea5y t\u1eeb \u0111\u1ea7u bu\u1ed5i h\u1ecdp l\u00e0 v\u1ec1 suy tim v\u00e0 sung huy\u1ebft. Ch\u00fang ta c\u1ea7n c\u00f3 s\u1ef1 h\u1ee3p t\u00e1c ch\u1eb7t ch\u1ebd h\u01a1n gi\u1eefa Ch\u00e2u \u00c1 v\u00e0 Ch\u00e2u \u00c2u \u0111\u1ec3 c\u1ed1 g\u1eafng x\u00e1c nh\u1eadn […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":7343,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[663,671,672],"tags":[675,677,673,676],"specialty":[696],"class_list":["post-7340","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-quan-diem-moi-nhat","category-apsc-2023-vi","category-strong-hf-vi","tag-acute-heart-failure-vi","tag-guideline-directed-medical-therapy-vi","tag-nt-probnp-vi","tag-strong-hf-vi","specialty-cardiovascular-vi"],"acf":[],"_links":{"self":[{"href":"https:\/\/cardiothinklab.com\/vi\/wp-json\/wp\/v2\/posts\/7340","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiothinklab.com\/vi\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiothinklab.com\/vi\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiothinklab.com\/vi\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiothinklab.com\/vi\/wp-json\/wp\/v2\/comments?post=7340"}],"version-history":[{"count":13,"href":"https:\/\/cardiothinklab.com\/vi\/wp-json\/wp\/v2\/posts\/7340\/revisions"}],"predecessor-version":[{"id":8961,"href":"https:\/\/cardiothinklab.com\/vi\/wp-json\/wp\/v2\/posts\/7340\/revisions\/8961"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiothinklab.com\/vi\/wp-json\/wp\/v2\/media\/7343"}],"wp:attachment":[{"href":"https:\/\/cardiothinklab.com\/vi\/wp-json\/wp\/v2\/media?parent=7340"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiothinklab.com\/vi\/wp-json\/wp\/v2\/categories?post=7340"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiothinklab.com\/vi\/wp-json\/wp\/v2\/tags?post=7340"},{"taxonomy":"specialty","embeddable":true,"href":"https:\/\/cardiothinklab.com\/vi\/wp-json\/wp\/v2\/specialty?post=7340"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}