safetyriskБезопасность и риск фармакотерапииSafety and Risk of Pharmacotherapy2312-78212619-1164Federal State Budgetary Institution ‘Scientific Centre for Expert Evaluation of Medicinal Products’ of the Ministry of Health of the Russian Federation (FSBI ‘SCEEMP’)10.30895/2312-7821-2020-8-2-57-65safetyrisk-172Research ArticleОБЗОРЫREVIEWSЛекарственно-индуцированная сердечная недостаточность (часть 2: механизмы развития, клиническая картина, дифференциальная диагностика, факторы риска, лечение и профилактика)Drug-Induced Heart Failure (Part 2: Mechanisms of Development, Clinical Signs, Differential Diagnosis, Risk Factors, Treatment and Prevention)https://orcid.org/0000-0002-0795-8225ОстроумоваО. Д.OstroumovaO. D.

д-р мед. наук, профессор,

ул. Баррикадная, д. 2/1, стр. 1, Москва, 125993

Dr. Sci. (Med.), Professor,

2/1/1 Barrikadnaya St., Moscow 125993

ostroumova.olga@mail.ruhttps://orcid.org/0000-0003-4583-6330ГолобородоваИ. В.GoloborodovaI. V.

канд. мед. наук,

ул. Делегатская, д. 20/1, Москва, 127423

Cand. Sci. (Med.),

20/1 Delegatskaya St., Moscow 127423

giv55555@rambler.ruФедеральное государственное бюджетное образовательное учреждение дополнительного профессионального образования «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской ФедерацииРоссияRussian Medical Academy of Continuous Professional EducationRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Московский государственный медико-стоматологический университет им. А. И. Евдокимова» Министерства здравоохранения Российской ФедерацииРоссияA.I. Yevdokimov Moscow State University of Medicine and DentistryRussian Federation202012052020825765Copyright © Остроумова О.Д., Голобородова И.В., 20202020Остроумова О.Д., Голобородова И.В.Ostroumova O.D., Goloborodova I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.risksafety.ru/jour/article/view/172

Сердечная недостаточность представляет собой сложный клинический синдром, обусловленный нарушением насосной функции сердечной мышцы, этиологически связанный с сердечно-сосудистыми заболеваниями и в абсолютном большинстве случаев требующий применения сложных терапевтических схем с назначением нескольких лекарственных средств одновременно. К настоящему времени известно несколько классов лекарственных средств (в том числе используемых при сердечной недостаточности), представители которых могут индуцировать развитие/прогрессирование сердечной недостаточности как у лиц, имеющих дисфункцию левого желудочка, так и у пациентов, не имеющих заболеваний сердца и сосудов. Цель работы: анализ и систематизация данных о механизмах развития, способах профилактики и терапии лекарственно-индуцированной сердечной недостаточности при применении различных групп лекарственных средств. Установлено, что наиболее часто лекарственно-индуцированная сердечная недостаточность развивается на фоне применения блокаторов кальциевых каналов (верапамил, дилтиазем, нифедипин), бета-адреноблокаторов, антиаритмических препаратов (дизопирамид, флекаинид, пропафенон, амиодарон, ибутилид, дофетилид, дронедарон), антрациклинов (доксорубицин) и других противоопухолевых средств (трастузумаб, бевацизумаб, инфликсимаб), гипогликемических препаратов (тиазолидиндионы, саксаглиптин, алоглиптин), нестероидных противовоспалительных средств, в том числе селективных ингибиторов циклооксигеназы-2. Выявлены различные механизмы развития сердечной недостаточности, ассоциированной с применением лекарственных средств. Развитие этой патологии может быть связано с кардиотоксическим действием конкретного препарата, а также с неблагоприятным воздействием на гемодинамику. Большое значение имеет наличие факторов риска развития сердечной недостаточности, включая специфические, характерные для групп лекарственных средств и отдельных препаратов. Выявление лекарственных средств, которые могут способствовать развитию/прогрессированию сердечной недостаточности, и возможных клинических проявлений этого состояния, своевременное информирование врачей и привлечение клинических фармакологов для оптимизации лечебного процесса может способствовать своевременной диагностике, лечению и профилактике сердечной недостаточности, вызванной применением лекарственных средств.

Heart failure is a complex clinical syndrome caused by an impaired pumping function of the heart muscle, etiologically associated with cardiovascular disease and, in the vast majority of cases, requiring complex therapeutic regimens and simultaneous prescription of several drugs. To date, we know several classes of drugs (including those used for heart failure) which can induce development/progression of heart failure in both patients with left ventricular dysfunction, and in patients who do not have cardiovascular diseases. The aim of the study was to analyse and systematize data on development mechanisms, as well as methods of prevention and treatment of drug-induced heart failure when using diff erent groups of drugs. It has been established that drug-induced heart failure is most often associated with the use of calcium channel blockers (verapamil, diltiazem, nifedipine), beta-blockers, antiarrhythmic drugs (disopyramide, fl ecainide, propafenone, amiodarone, ibutilide, dofetilide, dronedarone), anthracyclines (doxorubicin) and other antitumor drugs (trastuzumab, bevacizumab, infl iximab), hypoglycemic drugs (thiazolidinediones, saxagliptin, alogliptin), and nonsteroidal anti-infl ammatory drugs, including selective cyclooxygenase-2 inhibitors. The study revealed various mechanisms of heart failure development following drug treatment. In some patients, heart failure development is associated with the cardiotoxic eff ect of a particular drug, in others with adverse eff ects on hemodynamics. Much depends on risks of developing heart failure, including specifi c risks attributable to groups of drugs and individual drugs. The identifi cation of drugs that can contribute to the development/ progression of heart failure, and possible clinical manifestations of drug-induced heart failure, as well as provision of timely information to physicians, and engagement of clinical pharmacologists with the aim of optimizing treatment of patients can facilitate timely diagnosis, treatment and prevention of drug-induced heart failure. 

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