Usporedba naprednih metoda liječenja u uznapredovalom zatajivanju srca

master's thesis

• Title (english): Comparison of advanced treatment methods in advanced heart failure
• Author: Stjepan Skok
• Mentor: Matias Trbušić (mentor)
• Committee member: Diana Delić-Brkljačić (predsjednik povjerenstva)
• Committee member: Boško Skorić (član povjerenstva)
• Committee member: Matias Trbušić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2024-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Zatajivanje srca je složeni sindrom koji može nastati kao posljedica bilo kojeg poremećaja koji remeti funkciju srca. Riječ je o sindromu koji u današnje vrijeme predstavlja veliki javnozdravstveni problem s procijenjenom prevalencijom od 64 milijuna oboljelih u ukupnoj svjetskoj populaciji. Unatoč postignutom napretku s konvencionalnim terapijskim opcijama, u otprilike 13% oboljelih pacijenata zabilježena je progresija bolesti do stadija koji se naziva uznapredovalo zatajivanje srca. Riječ je o stadiju za koji je karakteristično: razvoj teških i za život onesposobljavajućih simptoma, otpornost na primjenu konvencionalne terapije, zatajivanje ciljnih organa uz potrebu primjene nadomjesne terapije kao i inotropnih lijekova za potporu srčane funkcije, rekurentne hospitalizacije i visoka smrtnost. Kako primjena konvencionalnih terapijskih opcija u ovom stadiju nema ili ima vrlo ograničene učinke, te unatoč lošoj prognozi, takvi se pacijenti smatraju kandidatima za primjenu naprednih metoda liječenja u koje se ubrajaju transplantacija srca i uređaj za potporu funkcije lijevog ventrikula (LVAD). U današnje vrijeme, terapijom zlatnog standarda smatra se transplantacija srca, iako se sve češće počinje koristiti i LVAD s kojim se bilježe sve bolji ishodi pacijenata. Za razliku od transplantacije koja je uvijek definitivna terapijska opcija, LVAD se može koristiti u više indikacija od kojih su 2 najčešće: za premoštenje perioda do transplantacije (eng. bridge to transplantation) ili kao definitivna terapija (eng. destination therapy). Svaka od opcija ima svoje prednosti i nedostatke, kontraindikacije kao i moguće komplikacije uslijed njezine primjene zbog čega je za svakog pojedinog pacijenta potrebno provesti individualizirani i multidisciplinarni pristup u procesu donošenja odluka o primjeni pojedine terapijske metode. Usporedbom istraživanja koja su proučavala učinkovitost i ishode ovih dviju metoda nisu pronađene značajne razlike, no u budućnosti je potrebno provesti dodatna istraživanja kako bi se utvrdili dugoročni ishodi i prikupili jasni dokazi o učinkovitosti ovih metoda u liječenju pacijenata sa uznapredovalim zatajivanjem srca.

Abstract (english)

Heart failure is a complex syndrome that can result from any structural or functional disorder that disrupts the function of the heart. It is a syndrome that today represents a major public health problem with an estimated prevalence of 64 million affected individuals in the global population. Despite advances in conventional therapeutic options, approximately 13% of affected patients experience disease progression to a stage known as advanced heart failure. This stage is characterized by the development of severe and life-disabling symptoms, resistance to conventional therapy, target organ failure requiring replacement therapy and inotropic drugs to support cardiac function, recurrent hospitalizations, and high mortality. As conventional therapeutic options in this stage have no or very limited effects, and despite the poor prognosis, such patients are considered candidates for the application of advanced treatment methods, which include heart transplantation and a left ventricular assist device (LVAD). Nowdays, heart transplantation is regarded as the gold standard therapy, although LVAD is increasingly being used with increasingly better patient outcomes. Unlike transplantation, which is always a definitive therapeutic option, LVAD can be used for multiple indications, two of which are the most common: bridging the period until transplantation (bridge to transplantation) or as a definitive therapy (destination therapy). Each option has its advantages and disadvantages, contraindications and possible complications due to its application, requiring an individualized and multidisciplinary approach in the decision-making process regarding the application of a particular therapeutic method for each patient. By comparing studies that have examined the effectiveness of these two methods, it has been determined that there are no significant differences. However, additional research is needed in the future to determine long-term outcomes and obtain clear evidence on the effectiveness of these methods in treating patients with advanced heart failure.

• Keywords: uznapredovalo zatajivanje srca; transplantacija srca; LVAD
• Keywords (english): advanced heart failure; heart transplantation; LVAD
• Language: croatian
• URN:NBN: urn:nbn:hr:105:480054
• 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: 2024-06-18 15:44:17