Procjena rizika i prevencija nagle srčane smrti-uloga ugradbenog kardioverter defibrilatora

master's thesis

• Title (english): Risk assessment and prevention of sudden cardiac death- the role of implantable cardioverter-defibrillator
• Author: Martina Gregur
• Mentor: Vedran Velagić (mentor)
• Committee member: Jure Samardžić (predsjednik povjerenstva)
• Committee member: Martina Lovrić Benčić (član povjerenstva)
• Committee member: Vedran Velagić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2022-09-02, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Nagla srčana smrt (NSS) definira se kao neočekivana smrt kojoj je uzrok poremećaj rada srca, a koja nastupi unutar jednog sata od početka simptoma. Procjenjuje se da je na godišnjoj razini zbog NSS izgubljeno više od 7 milijuna života. NSS može nastupiti kod osoba koje imaju poznatu srčanu bolest ili se javlja kao prvi događaj u bolesnika bez poznate srčane patologije (prva prezentacija). Među najvažnijim uzrocima jesu koronarna bolest srca, kardiomiopatije i zatajivanje srca. Kao posljedica tih uzroka nastaju opasne ventrikulske aritmije (VA), od kojih 80% čine ventrikularna fibrilacija (VF) i ventrikularna tahikardija (VT). Ejekcijska frakcija lijevog ventrikula (LVEF) trenutno je najbolji prediktor rizika za NSS, no uz značajno ograničenje niske specifičnosti i senzitivnosti. Pronalaskom pouzdanijih prognostičkih čimbenika rizika za NSS, omogućila bi se kvalitetnija stratifikacija rizika. Najveći je izazov otkriti pojedince koji nemaju identificiranu bolest, ali su pod velikim rizikom nastanka NSS kao prvog srčanog događaja. Prepoznavanje visokorizičnih osoba iznimno je važno budući da postoji učinkovita metoda prevencije u vidu ugradbenog kardioverter-defibrilatora (ICD). Primarna prevencija NSS odnosi se na pojedince koji su pod povećanim rizikom za NSS, ali još nisu doživjeli životno ugrožavajuću aritmiju ili nagli srčani zastoj (NSZ). Suprotno tome, sekundarna prevencija NSS odnosi se na pojedince koji su preživjeli životno ugrožavajuću aritmiju ili NSZ. Sve randomizirane studije o prevenciji NSS pokazale su da je terapija ICD-om učinkovitija u odnosu na terapiju antiaritmijskim lijekovima.

Abstract (english)

Sudden cardiac death (SCD) is defined as unexpected death caused by abrupt loss of heart function that occurs within one hour of the onset of symptoms. It is estimated that more than 7 million lives are lost annually due to SCD. SCD can occur in people who have known heart disease or occurs as the first event in patients without known heart pathology (first presentation). Among the most important causes are coronary heart disease, cardiomyopathies and heart failure. These causes result in dangerous ventricular arrhythmias (VA), of which 80% are ventricular fibrillation (VF) and ventricular tachycardia (VT). Left ventricular ejection fraction (LVEF) is currently the best predictor of SCD risk, but with the serious limitation of low specificity and sensitivity. By finding more reliable prognostic risk factors for SCD, better risk stratification would be possible. The biggest challenge is to detect individuals who do not have an identified disease, but are at high risk of developing SCD as a first cardiac event. Recognizing high-risk individuals is extremely important since there is an effective method of prevention in the form of an implanted cardioverter-defibrillator (ICD) therapy. Primary prevention of SCD refers to individuals who are at increased risk for SCD but have not yet experienced a life-threatening arrhythmia or sudden cardiac arrest (SCA). Conversely, secondary prevention of SCD refers to individuals who have survived a life-threatening arrhythmia or SCD. All randomized studies on SCD prevention have shown that ICD therapy is more effective than antiarrhythmic drug therapy.

• Keywords: nagla srčana smrt; primarna prevencija; sekundarna prevencija; stratifikacija rizika; ventrikulske aritmije; ugradbeni kardioverter-defibrilator
• Keywords (english): sudden cardiac death; primary prevention; secondary prevention; risk stratification; ventricular arrhythmias; implantable cardioverter-defibrillator
• Language: croatian
• URN:NBN: urn:nbn:hr:105:119888
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-01-09 09:09:47