{"id":12692,"date":"2023-11-22T22:14:59","date_gmt":"2023-11-22T14:14:59","guid":{"rendered":"https:\/\/docquity.com\/?post_type=articles&#038;p=12692"},"modified":"2025-02-11T13:37:57","modified_gmt":"2025-02-11T05:37:57","slug":"acc-2023-huong-dan-kiem-soat-suy-tim-phan-suat-tong-mau-bao-ton","status":"publish","type":"articles","link":"https:\/\/docquity.com\/vi\/articles\/acc-2023-huong-dan-kiem-soat-suy-tim-phan-suat-tong-mau-bao-ton\/","title":{"rendered":"ACC 2023: H\u01b0\u1edbng d\u1eabn ki\u1ec3m so\u00e1t suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n"},"content":{"rendered":"\n<p>M\u1eb7c d\u00f9 c\u00f3 nhi\u1ec1u ti\u1ebfn b\u1ed9 trong \u0111i\u1ec1u tr\u1ecb, suy tim v\u1eabn l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh m\u1eafc k\u00e8m v\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u1eed vong h\u00e0ng \u0111\u1ea7u th\u1ebf gi\u1edbi. \u1ede Hoa K\u1ef3 n\u00f3i ri\u00eang, m\u1eb7c d\u00f9 t\u1ef7 l\u1ec7 m\u1eafc suy tim nh\u00ecn chung gi\u1ea3m, nh\u01b0ng t\u1ef7 l\u1ec7 m\u1eafc suy tim ph\u00e2n su\u1ea5t m\u00e1u b\u1ea3o t\u1ed3n v\u1eabn ti\u1ebfp t\u1ee5c c\u00f3 xu h\u01b0\u1edbng t\u0103ng. Suy tim ph\u00e2n su\u1ea5t m\u00e1u b\u1ea3o t\u1ed3n chi\u1ebfm \u0111\u1ebfn h\u01a1n 50% tr\u01b0\u1eddng h\u1ee3p m\u1eafc suy tim.<\/p>\n\n\n\n<p>Tr\u01b0\u1edbc \u0111\u00e2y, ki\u1ec3m so\u00e1t suy tim ch\u1ec9 gi\u1edbi h\u1ea1n trong vi\u1ec7c ki\u1ec3m so\u00e1t c\u00e1c b\u1ec7nh m\u1eafc k\u00e8m. Tuy nhi\u00ean, trong nhi\u1ec1u th\u1eadp k\u1ef7 qua \u0111\u00e3 c\u00f3 nhi\u1ec1u ti\u1ebfn b\u1ed9 v\u1ec1 m\u1eb7t sinh b\u1ec7nh h\u1ecdc, ch\u1ea9n \u0111o\u00e1n, ti\u00ean l\u01b0\u1ee3ng v\u00e0 chi\u1ebfn l\u01b0\u1ee3c ki\u1ec3m so\u00e1t suy tim ph\u00e2n su\u1ea5t m\u00e1u b\u1ea3o t\u1ed3n. H\u01b0\u1edbng d\u1eabn ki\u1ec3m so\u00e1t suy tim ph\u00e2n su\u1ea5t m\u00e1u b\u1ea3o t\u1ed3n c\u1ee7a Vi\u1ec7n Tim m\u1ea1ch Hoa K\u1ef3 (American College of Cardiology \u2013 ACC) n\u0103m 2023 \u0111\u01b0\u1ee3c \u0111\u01b0a ra nh\u1eb1m cung c\u1ea5p nh\u1eefng khuy\u1ebfn c\u00e1o d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng m\u1edbi \u0111\u1ec3 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng ch\u0103m s\u00f3c b\u1ec7nh nh\u00e2n suy tim<sup>1<\/sup>.<\/p>\n\n\n\n<p>B\u00e0i vi\u1ebft xin l\u01b0\u1ee3c d\u1ecbch ng\u1eafn g\u1ecdn nh\u1eefng \u0111i\u1ec3m m\u1edbi v\u1ec1 chi\u1ebfn l\u01b0\u1ee3c ki\u1ec3m so\u00e1t suy tim ph\u00e2n su\u1ea5t m\u00e1u gi\u1ea3m.<\/p>\n\n\n\n<p><strong>T\u00d3M L\u01af\u1ee2C<\/strong><\/p>\n\n\n\n<p>Nhi\u1ec1u b\u1ec7nh nh\u00e2n suy tim t\u00ecm \u0111\u1ebfn trung t\u00e2m ch\u0103m s\u00f3c ban \u0111\u1ea7u v\u00ec nh\u1eefng tri\u1ec7u ch\u1ee9ng nh\u01b0 kh\u00f3 th\u1edf, g\u1eb7p kh\u00f3 kh\u0103n khi v\u1eadn \u0111\u1ed9ng v\u00e0\/ho\u1eb7c d\u1ea5u hi\u1ec7u sung huy\u1ebft. Nh\u00e2n vi\u00ean y t\u1ebf l\u00e0m vi\u1ec7c \u1edf trung t\u00e2m ch\u0103m s\u00f3c ban \u0111\u1ea7u n\u00ean nh\u1eadn th\u1ee9c \u0111\u01b0\u1ee3c suy tim ph\u00e2n su\u1ea5t m\u00e1u b\u1ea3o t\u1ed3n khi ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t kh\u00f3 th\u1edf, g\u1eb7p kh\u00f3 kh\u0103n khi v\u1eadn \u0111\u1ed9ng v\u00e0 ph\u00f9.<\/p>\n\n\n\n<p>N\u00ean ti\u1ebfn h\u00e0nh x\u00e9t nghi\u1ec7m sau khi c\u00e2n nh\u1eafc ti\u1ec1n s\u1eed v\u00e0 th\u0103m kh\u00e1m l\u00e2m s\u00e0ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n lo\u1ea1i tr\u1eeb v\u00e0 x\u00e1c \u0111\u1ecbnh c\u00e1c b\u1ec7nh l\u00fd m\u1eafc k\u00e8m. N\u00ean \u0111\u01b0a ra k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb ch\u00fa tr\u1ecdng v\u00e0o vi\u1ec7c ki\u1ec3m so\u00e1t b\u1ec7nh m\u1eafc k\u00e8m v\u00e0 c\u00e1c bi\u1ec7n ph\u00e1p ki\u1ec3m so\u00e1t kh\u00f4ng d\u00f9ng thu\u1ed1c v\u00e0 ph\u00e1c \u0111\u1ed3 d\u00f9ng thu\u1ed1c theo h\u01b0\u1edbng d\u1eabn. V\u00ec b\u1ec7nh nh\u00e2n suy tim th\u01b0\u1eddng kh\u00f4ng ch\u1ee7 \u0111\u1ed9ng t\u00ecm \u0111\u1ebfn b\u00e1c s\u0129 tim m\u1ea1ch ngay t\u1eeb ban \u0111\u1ea7u, do v\u1eady ch\u0103m s\u00f3c li\u00ean ng\u00e0nh l\u00e0 m\u1ed9t trong nh\u1eefng gi\u1ea3i ph\u00e1p quan tr\u1ecdng trong ki\u1ec3m so\u00e1t b\u1ec7nh nh\u00e2n suy tim<sup>1<\/sup>.<\/p>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-259bcd0d3dcd0b80b618cc3cea1c6aea.png\"><strong>H\u00ecnh 1.<\/strong>&nbsp;Ti\u1ebfp c\u1eadn ch\u0103m s\u00f3c b\u1ec7nh nh\u00e2n suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n<\/p>\n\n\n\n<p><strong>KI\u1ec2M SO\u00c1T SUY TIM PH\u00c2N SU\u1ea4T M\u00c1U B\u1ea2O T\u1ed2N<\/strong><\/p>\n\n\n\n<p>Ki\u1ec3m so\u00e1t suy tim ph\u00e2n su\u1ea5t m\u00e1u b\u1ea3o t\u1ed3n n\u00ean t\u1eadp trung v\u00e0o nh\u1eefng v\u1ea5n \u0111\u1ec1 sau:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ph\u00e2n t\u1ea7ng nguy c\u01a1 v\u00e0 ki\u1ec3m so\u00e1t b\u1ec7nh m\u1eafc k\u00e8m, bao g\u1ed3m t\u0103ng huy\u1ebft \u00e1p, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, b\u00e9o ph\u00ec, rung ngh\u0129, b\u1ec7nh m\u1ea1ch v\u00e0nh, b\u1ec7nh th\u1eadn m\u1ea1n v\u00e0 ng\u01b0ng th\u1edf t\u1eafc ngh\u1ebdn khi ng\u1ee7.<\/li>\n\n\n\n<li>Ki\u1ec3m so\u00e1t kh\u00f4ng d\u00f9ng thu\u1ed1c, bao g\u1ed3m t\u1eadp th\u1ec3 d\u1ee5c, gi\u1ea3m c\u00e2n v\u00e0 s\u1eed d\u1ee5ng thi\u1ebft b\u1ecb theo d\u00f5i \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i kh\u00f4ng d\u00e2y c\u1ea5y \u0111\u01b0\u1ee3c.<\/li>\n\n\n\n<li>Ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng v\u00e0 gi\u1ea3m nh\u1eb9 b\u1eb1ng thu\u1ed1c l\u1ee3i ti\u1ec3u quai, thu\u1ed1c \u1ee9c ch\u1ebf k\u00eanh \u0111\u1ed3ng v\u1eadn chuy\u1ec3n natri-glucose 2 (sodium \u2013 glucose cotransporter 2 inhibitor \u2013 SGLT2i), ch\u1ea5t \u0111\u1ed1i v\u1eadn th\u1ee5 th\u1ec3 mineralocorticoid (mineralocorticoid antagonist \u2013 MRA), ch\u1ea5t \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin neprilysin (angiotensin receptor\u2013neprilysin inhibitor \u2013 ARNI) v\u00e0 ch\u1ea5t ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin (angiotensin receptor blocker \u2013 ARB).<\/li>\n<\/ul>\n\n\n\n<p><strong>Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n theo h\u01b0\u1edbng d\u1eabn<\/strong><\/p>\n\n\n\n<p>Nhi\u1ec1u th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng \u0111\u00e3 ch\u1ee9ng minh \u0111\u01b0\u1ee3c l\u1ee3i \u00edch c\u1ee7a ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb theo h\u01b0\u1edbng d\u1eabn \u1edf b\u1ec7nh nh\u00e2n suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n. Kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c l\u00e0 gi\u1ea3i ph\u00e1p quan tr\u1ecdng \u0111\u1ec3 c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng v\u00e0 ch\u1ee9c n\u0103ng, \u0111\u1ed3ng th\u1eddi gi\u1ea3m g\u00e1nh n\u1eb7ng c\u1ee7a b\u1ec7nh t\u1eadt v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong li\u00ean quan \u0111\u1ebfn suy tim<sup>2 \u2013 6<\/sup>. Kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u00e1c \u0111\u1ed3 theo h\u01b0\u1edbng d\u1eabn l\u00e0 l\u1ef1a ch\u1ecdn an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 \u0111\u1ed1i v\u1edbi c\u1ea3 suy tim c\u1ea5p v\u00e0 m\u1ea1n t\u00ednh. Li\u1ec1u kh\u1edfi \u0111\u1ea7u v\u00e0 li\u1ec1u \u0111\u00edch khuy\u1ebfn c\u00e1o trong ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n theo h\u01b0\u1edbng d\u1eab \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n trong b\u1ea3ng 1. N\u00ean c\u00e2n nh\u1eafc nh\u1eefng th\u1eadn tr\u1ecdng v\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh khi k\u00ea \u0111\u01a1n (b\u1ea3ng 2, h\u00ecnh 2).<\/p>\n\n\n\n<p><strong>B\u1ea3ng 1.<\/strong>&nbsp;Li\u1ec1u kh\u1edfi \u0111\u1ea7u v\u00e0 li\u1ec1u \u0111\u00edch c\u1ee7a c\u00e1c thu\u1ed1c trong ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n theo h\u01b0\u1edbng d\u1eabn<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-8a40e5c207addf8359faa22c55d66e04.png\" alt=\"\" \/><\/figure>\n\n\n\n<p><strong>B\u1ea3ng 2.<\/strong>&nbsp;Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 th\u1eadn tr\u1ecdng cho SGLT2i, MRA, ARNI v\u00e0 ARB<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-f78af8d22506e74c6f42678b209a6298.png\" alt=\"\" \/><\/figure>\n\n\n\n<p>Thu\u1ed1c l\u1ee3i ti\u1ec3u n\u00ean \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn m\u1ed9t c\u00e1ch th\u1eadn tr\u1ecdng n\u1ebfu c\u1ea7n thi\u1ebft \u0111\u1ec3 gi\u1ea3m sung huy\u1ebft v\u00e0 c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng. N\u00ean ch\u00fa \u00fd r\u1eb1ng thu\u1ed1c ch\u1eb9n beta c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn cho b\u1ec7nh nh\u00e2n suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n c\u00f3 ch\u1ec9 \u0111\u1ecbnh, bao g\u1ed3m b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed nh\u1ed3i m\u00e1u c\u01a1 tim (trong 3 n\u0103m tr\u1edf l\u1ea1i \u0111\u00e2y), \u0111au th\u1eaft ng\u1ef1c ho\u1eb7c rung nh\u0129, tuy nhi\u00ean n\u00ean theo d\u00f5i kh\u1ea3 n\u0103ng dung n\u1ea1p v\u1eadn \u0111\u1ed9ng do nguy c\u01a1 m\u1ea5t kh\u1ea3 n\u0103ng \u0111i\u1ec1u bi\u1ebfn t\u1ea7n s\u1ed1<sup>1<\/sup>.<\/p>\n\n\n\n<p>1.&nbsp;<strong><em>Ch\u1ea5t \u1ee9c ch\u1ebf k\u00eanh \u0111\u1ed3ng v\u1eadn chuy\u1ec3n natri-glucose 2 \u2013 SGLT2i<\/em><\/strong><\/p>\n\n\n\n<p>SGLT2i ban \u0111\u1ea7u \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u v\u00e0 ph\u00e1t tri\u1ec3n nh\u1eb1m m\u1ee5c \u0111\u00edch ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2. Sau \u0111\u00f3, SGLT2i \u0111\u00e3 cho th\u1ea5y l\u1ee3i \u00edch tr\u00ean tim m\u1ea1ch ngay c\u1ea3 \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2. C\u1ee5 th\u1ec3, SGLT2i l\u00e0m gi\u1ea3m c\u00f3 \u00fd ngh\u0129a nguy c\u01a1 nh\u1eadp vi\u1ec7n do suy tim v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong do tim m\u1ea1ch \u1edf m\u1ecdi ph\u00e2n nh\u00f3m b\u1ec7nh nh\u00e2n suy tim. Do v\u1eady, SGLT2i n\u00ean \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb cho m\u1ecdi b\u1ec7nh nh\u00e2n suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n m\u00e0 kh\u00f4ng b\u1ecb ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh.<\/p>\n\n\n\n<p>Nh\u1eefng th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng \u0111\u00e1nh gi\u00e1 tr\u1ef1c ti\u1ebfp hi\u1ec7u l\u1ef1c c\u1ee7a SGLT2i \u1edf b\u1ec7nh nh\u00e2n suy tim c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i \u2265 40% bao g\u1ed3m DELIVER (dapagliflozin) v\u00e0 EMPEROR-Preserved (empagliflozin). K\u1ebft qu\u1ea3 c\u1ee7a ph\u00e2n t\u00edch g\u1ed9p c\u0169ng cho th\u1ea5y SGLT2i c\u0169ng c\u00f3 l\u1ee3i \u00edch trong vi\u1ec7c c\u1ea3i thi\u1ec7n t\u1ed5ng tr\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n, \u0111\u1eb7c bi\u1ec7t l\u00e0 gi\u1ea3m nh\u1eb9 tri\u1ec7u ch\u1ee9ng [7, 8]. G\u1ea7n \u0111\u00e2y, th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng EMPULSE nh\u1eb1m \u0111\u00e1nh gi\u00e1 hi\u1ec7u l\u1ef1c c\u1ee7a empagliflozin \u1edf b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n do suy tim m\u1ea5t b\u00f9 c\u1ea5p. K\u1ebft qu\u1ea3 cho th\u1ea5y empagliflozin c\u1ea3i thi\u1ec7n c\u00f3 \u00fd ngh\u0129a k\u1ebft c\u1ee5c g\u1ed9p th\u1ee9 ph\u00e1t (t\u1eed vong, bi\u1ebfn c\u1ed1 li\u00ean quan \u0111\u1ebfn suy tim) v\u00e0 t\u1ed5ng tr\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n<sup>9<\/sup>.<\/p>\n\n\n\n<p><em>Th\u00f4ng tin b\u00ean l\u1ec1:&nbsp;<\/em>Cu\u1ed1i th\u00e1ng 5\/2023, th\u00eam m\u1ed9t ho\u1ea1t ch\u1ea5t thu\u1ed9c nh\u00f3m SGLT2i \u2013 sotagliflozin \u0111\u00e3 \u0111\u01b0\u1ee3c C\u1ee5c Qu\u1ea3n l\u00fd Th\u1ef1c ph\u1ea9m v\u00e0 D\u01b0\u1ee3c ph\u1ea9m Hoa K\u1ef3 ch\u1ea5p thu\u1eadn cho ch\u1ec9 \u0111\u1ecbnh suy tim (c\u1ea3 suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m v\u00e0 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n). Click v\u00e0o \u0111\u01b0\u1eddng link \u0111\u1ec3 xem chi ti\u1ebft:&nbsp;<a href=\"https:\/\/docquity.app.link\/1I5L150fhAb\">https:\/\/docquity.app.link\/1I5L150fhAb<\/a><\/p>\n\n\n\n<p>2.&nbsp;<strong><em>Ch\u1ea5t \u0111\u1ed1i kh\u00e1ng mineralocorticoid \u2013 MRA<\/em><\/strong><\/p>\n\n\n\n<p>MRA c\u1ea3i thi\u1ec7n c\u00f3 \u00fd ngh\u0129a ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng \u1edf b\u1ec7nh nh\u00e2n suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n. Spironolactone c\u00f3 th\u1ec3 gi\u1ea3m nguy c\u01a1 nh\u1eadp vi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n, tuy nhi\u00ean, c\u1ea7n ph\u1ea3i theo d\u00f5i n\u1ed3ng \u0111\u1ed9 kali m\u00e1u v\u00e0 ch\u1ee9c n\u0103ng th\u1eadn \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 t\u0103ng kali m\u00e1u v\u00e0 suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn.<\/p>\n\n\n\n<p>M\u1eb7c d\u00f9 MRA kh\u00f4ng ch\u1ee9ng minh \u0111\u01b0\u1ee3c l\u1ee3i \u00edch c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng ho\u1eb7c kh\u1ea3 n\u0103ng v\u1eadn \u0111\u1ed9ng \u1edf b\u1ec7nh nh\u00e2n suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n, nh\u01b0ng MRA v\u1eabn cho th\u1ea5y l\u1ee3i \u00edch c\u00e2n b\u1eb1ng l\u1ee3i ti\u1ec3u, ki\u1ec3m so\u00e1t t\u00ecnh tr\u1ea1ng t\u0103ng huy\u1ebft \u00e1p v\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 nh\u1eadp vi\u1ec7n do suy tim.<\/p>\n\n\n\n<p>3.&nbsp;<strong><em>Ch\u1ea5t \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin neprilysin \u2013 ARNI<\/em><\/strong><\/p>\n\n\n\n<p>Sacubitril \u1ee9c ch\u1ebf neprilysin \u2013 enzym b\u1ea5t ho\u1ea1t nhi\u1ec1u peptide v\u1eadn m\u1ea1ch quan tr\u1ecdng tham gia v\u00e0o con \u0111\u01b0\u1eddng sinh b\u1ec7nh h\u1ecdc v\u00e0 ti\u1ebfn tri\u1ec3n c\u1ee7a suy tim. C\u00e1c peptide n\u00e0y bao g\u1ed3m: natriuretic peptide, bradykinin v\u00e0 h\u1ee3p ch\u1ea5t P. Vi\u1ec7c ph\u1ed1i h\u1ee3p v\u1edbi valsartan l\u00e0 c\u1ea7n thi\u1ebft, \u0111\u1ec3 kh\u00f4ng l\u00e0m \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn hi\u1ec7u qu\u1ea3 c\u1ee7a sacubitril. M\u1ed9t s\u1ed1 t\u00e1c \u0111\u1ed9ng b\u1ea5t l\u1ee3i nh\u01b0 t\u0103ng n\u1ed3ng \u0111\u1ed9 creatinine v\u00e0 t\u0103ng kali m\u00e1u \u00edt khi \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng sacubitril\/valsartan, tuy nhi\u00ean h\u1ea1 huy\u1ebft \u00e1p qu\u00e1 m\u1ee9c v\u00e0 ph\u00f9 m\u1ea1ch l\u1ea1i th\u01b0\u1eddng g\u1eb7p h\u01a1n.<\/p>\n\n\n\n<p>Hi\u1ec7u l\u1ef1c c\u1ee7a ARNI tr\u00ean b\u1ec7nh nh\u00e2n suy tim \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m qua nghi\u00ean c\u1ee9u PARAGON-HF [5]. Trong v\u0103n b\u1ea3n ch\u1ea5p thu\u1eadn ch\u1ec9 \u0111\u1ecbnh tr\u00ean b\u1ec7nh nh\u00e2n suy tim c\u1ee7a ARNI, FDA ph\u00e1t bi\u1ec3u r\u1eb1ng ARNI c\u00f3 th\u1ebb l\u00e0m gi\u1ea3m nguy c\u01a1 t\u1eed vong do tim m\u1ea1ch v\u00e0 nh\u1eadp vi\u1ec7n do suy tim \u1edf b\u1ec7nh nh\u00e2n tr\u01b0\u1edfng th\u00e0nh m\u1eafc suy tim m\u1ea1n. Nh\u1eefng l\u1ee3i \u00edch n\u00e0y \u0111\u01b0\u1ee3c quan s\u00e1t r\u00f5 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i d\u01b0\u1edbi m\u1ee9c b\u00ecnh th\u01b0\u1eddng.<\/p>\n\n\n\n<p>4.&nbsp;<strong><em>Ch\u1ea5t ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin \u2013 ARB<\/em><\/strong><\/p>\n\n\n\n<p>M\u1eb7c d\u00f9 ARNI c\u00f3 v\u1ebb c\u00f3 hi\u1ec7u qu\u1ea3 h\u01a1n ARB, nh\u01b0ng c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn ARB n\u1ebfu b\u1ec7nh nh\u00e2n b\u1ecb ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi ARNI. ACEi kh\u00f4ng \u0111\u01b0\u1ee3c xem l\u00e0 l\u1ef1a ch\u1ecdn thay th\u1ebf h\u1ee3p l\u00fd do perindopril kh\u00f4ng cho th\u1ea5y l\u1ee3i \u00edch trong th\u1eed nghi\u1ec7m PEP \u2013 CHF (th\u1eed nghi\u1ec7m tr\u00ean b\u1ec7nh nh\u00e2n cao tu\u1ed5i b\u1ecb suy tim m\u1ea1n t\u00ednh).<\/p>\n\n\n\n<p>Th\u1eed nghi\u1ec7m ch\u1ee9ng minh hi\u1ec7u l\u1ef1c c\u1ee7a ARB tr\u00ean b\u1ec7nh nh\u00e2n suy tim l\u00e0 CHARM (candesartan) v\u00e0 I \u2013 PRESERVE (ibesartan). CHARM cho th\u1ea5y candesartan c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m trung b\u00ecnh t\u1ef7 l\u1ec7 nh\u1eadp vi\u1ec7n do suy tim, tuy nhi\u00ean I-PRESERVE l\u1ea1i kh\u00f4ng c\u00f3 th\u1ea5y r\u1eb1ng ibersartan c\u00f3 b\u1ea5t k\u1ef3 l\u1ee3i \u00edch n\u00e0o trong vi\u1ec7c gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong do nguy\u00ean nh\u00e2n tim m\u1ea1ch ho\u1eb7c nh\u1eadp vi\u1ec7n tr\u00ean tim m\u1ea1ch [10, 11]. K\u1ebft qu\u1ea3 c\u1ee7a 2 th\u1eed nghi\u1ec7m kh\u00f4ng c\u00f3 s\u1ef1 \u0111\u1ed3ng thu\u1eadn, tuy nhi\u00ean t\u1ef7 l\u1ec7 ng\u01b0ng ibesartan l\u00ean t\u1edbi 34% v\u00e0 t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ACEi l\u00e0 40% trong I-PRESERVE. Nh\u1eefng y\u1ebfu t\u1ed1 n\u00e0y c\u00f3 th\u1ec3 l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn l\u1ee3i \u00edch ghi nh\u1eadn \u0111\u01b0\u1ee3c c\u1ee7a ibesartan, t\u1eeb \u0111o c\u00f3 nh\u1eefng kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 gi\u1eefa CHARM v\u00e0 I-PRESERVE.<\/p>\n\n\n\n<p>Kh\u00e1c bi\u1ec7t v\u1ec1 gi\u1edbi t\u00ednh trong ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb suy tim theo h\u01b0\u1edbng d\u1eabn<\/p>\n\n\n\n<p>Kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 \u0111\u00e3 ghi nh\u1eadn \u0111\u01b0\u1ee3c gi\u1eefa nam gi\u1edbi v\u00e0 n\u1eef gi\u1edbi trong \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb v\u1edbi suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n. N\u1eef gi\u1edbi b\u1ecb suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n c\u00f3 th\u1ec3 \u0111\u00e1p \u1ee9ng t\u1ed1t h\u01a1n v\u1edbi \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 l\u00e0 do n\u1eef gi\u1edbi th\u01b0\u1eddng c\u00f3 k\u00edch th\u01b0\u1edbc c\u1ee7a ph\u00f2ng th\u1ea5t tr\u00e1i nh\u1ecf h\u01a1n, t\u1eeb \u0111\u00f3 n\u1eef gi\u1edbi th\u01b0\u1eddng cho th\u1ea5y ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i cao h\u01a1n nam gi\u1edbi. N\u00f3i m\u1ed9t c\u00e1ch \u0111\u01a1n gi\u1ea3n h\u01a1n, ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i 50 \u2013 55% \u1edf n\u1eef gi\u1edbi c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem l\u00e0 th\u1ea5p so v\u1edbi nam gi\u1edbi.<\/p>\n\n\n\n<p><strong>Ti\u1ebfp c\u1eadn ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb theo h\u01b0\u1edbng d\u1eabn: kh\u1edfi \u0111\u1ea7u v\u00e0 ch\u1ec9nh li\u1ec1u<\/strong><\/p>\n\n\n\n<p>Ngo\u00e0i tr\u1eeb b\u1ec7nh nh\u00e2n b\u1ecb ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n suy tim ph\u00e2n su\u1ea5t m\u00e1u b\u1ea3o t\u1ed3n n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng SGLT2i \u0111\u1ec3 l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong do tim m\u1ea1ch v\u00e0 nh\u1eadp vi\u1ec7n do suy tim v\u00e0 c\u1ea3i thi\u1ec7n t\u1ed5ng tr\u1ea1ng. SGLT2i n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc kh\u1edfi \u0111\u1ea7u \u1edf c\u1ea3 b\u1ec7nh nh\u00e2n suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n ngo\u1ea1i tr\u00fa v\u00e0 b\u1ec7nh nh\u00e2n suy tim m\u1ea5t b\u00f9 c\u1ea5p. \u1ede b\u1ec7nh nh\u00e2n suy tim v\u1edbi ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i &lt; 55 \u2013 60%, MRA, ARNI ho\u1eb7c ARB (ARB trong tr\u01b0\u1eddng h\u1ee3p ARNI kh\u00f4ng s\u1eb5n c\u00f3) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc (h\u00ecnh 2). ARNI v\u00e0 MRA n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9nh \u0111\u1ebfn li\u1ec1u t\u1ed1i \u0111a c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c dung n\u1ea1p d\u1ef1a tr\u00ean tri\u1ec7u ch\u1ee9ng, huy\u1ebft \u00e1p, n\u1ed3ng \u0111\u1ed9 kali, creatinine.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-7b730d8c08fc0cd23f172ff5520c8e9b.png\" alt=\"\" \/><\/figure>\n\n\n\n<p><strong>H\u00ecnh 2.&nbsp;<\/strong>Kh\u1edfi \u0111\u1ea7u v\u00e0 ch\u1ec9nh li\u1ec1u c\u00e1c thu\u1ed1c trong ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb suy tim<\/p>\n\n\n\n<p><strong>Bi\u1ec7n ph\u00e1p kh\u00f4ng d\u00f9ng thu\u1ed1c<\/strong><\/p>\n\n\n\n<p><strong>1.&nbsp;<em>T\u1eadp th\u1ec3 d\u1ee5c v\u00e0 h\u1ea1n ch\u1ebf calo<\/em><\/strong><\/p>\n\n\n\n<p>Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb suy tim c\u00f3 th\u1ec3 h\u1ed7 tr\u1ee3 l\u00e0m gi\u1ea3m tri\u1ec7u ch\u1ee9ng suy tim, nguy c\u01a1 nh\u1eadp vi\u1ec7n v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong. Gi\u1ea3m kh\u1ea3 n\u0103ng v\u1eadn \u0111\u1ed9ng m\u00e0 tri\u1ec7u ch\u1ee9ng quan tr\u1ecdng c\u1ee7a suy tim ph\u00e2n su\u1ea5t m\u00e1u b\u1ea3o t\u1ed3n, do v\u1eady, c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng v\u1eadn \u0111\u1ed9ng l\u00e0 m\u1ed9t trong nh\u1eefng m\u1ee5c ti\u00eau quan tr\u1ecdng. \u0110\u1ec3 c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng v\u1eadn \u0111\u1ed9ng c\u1ee7a b\u1ec7nh nh\u00e2n, h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb khuy\u1ebfn c\u00e1o n\u00ean t\u1ed1i \u01b0u h\u00f3a ki\u1ec3m so\u00e1t th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh m\u1eafc k\u00e8m.<\/p>\n\n\n\n<p>L\u1ed1i s\u1ed1ng t\u0129nh t\u1ea1i v\u00e0 b\u00e9o ph\u00ec c\u00f3 m\u1ed1i li\u00ean h\u1ec7 ch\u1eb7t ch\u1ebd v\u1edbi t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe kh\u00f4ng t\u1ed1i \u01b0u v\u00e0 ti\u00ean l\u01b0\u1ee3ng suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n x\u1ea5u h\u01a1n. N\u00ean tu\u00e2n th\u1ee7 khuy\u1ebfn c\u00e1o trong h\u01b0\u1edbng d\u1eabn c\u1ee7a ACC\/AHA n\u0103m 2019 v\u1ec1 vi\u1ec7c ph\u00f2ng ng\u1eeba b\u1ec7nh tim m\u1ea1ch, bao g\u00f2m t\u1ef1 gi\u00e1m s\u00e1t ch\u1ebf \u0111\u1ed9 \u0103n, ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t v\u00e0 c\u00e2n n\u1eb7ng. T\u0103ng c\u01b0\u1eddng v\u1eadn \u0111\u1ed9ng, \u01b0u ti\u00ean c\u00e1c b\u00e0i t\u1eadp aerobic trong \u2265 150 ph\u00fat\/tu\u1ea7n \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3 gi\u1ea3m c\u00e2n.<\/p>\n\n\n\n<p>V\u1ec1 v\u1ea5n \u0111\u1ec1 t\u1eadp th\u1ec3 d\u1ee5c, m\u1ed9t th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng tr\u00ean h\u01a1n 100 b\u1ec7nh nh\u00e2n suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n m\u1eafc k\u00e8m b\u00e9o ph\u00ec cho th\u1ea5y t\u1eadp th\u1ec3 d\u1ee5c c\u00f3 th\u1ec3 c\u00f3 l\u1ee3i \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng. M\u1eb7c d\u00f9 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng g\u00e2y ra nhi\u1ec1u \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng v\u00e0 c\u00e1c b\u1ec7nh m\u1eafc k\u00e8m. Tuy nhi\u00ean, th\u1eed nghi\u1ec7m ph\u00e2n b\u1ed1 ng\u1eabu nhi\u00ean v\u1edbi c\u1ee1 m\u1eabu l\u1edbn h\u01a1n l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00e1c \u0111\u1ed9ng c\u1ee7a v\u1eadn \u0111\u1ed9ng \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh.<\/p>\n\n\n\n<p><strong>2.&nbsp;<em>Theo d\u00f5i \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/em><\/strong><\/p>\n\n\n\n<p>Ki\u1ec3m so\u00e1t th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n l\u00e0 m\u1ed9t tr\u1ecdng nh\u1eefng chi\u1ebfn l\u01b0\u1ee3c quan tr\u1ecdng trong ki\u1ec3m so\u00e1t suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n, do v\u1eady, c\u00e1c thi\u1ebft b\u1ecb \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n \u0111\u1ec3 theo d\u00f5i \u00e1p l\u1ef1c l\u00e0m \u0111\u1ea7y \u0111\u1ec3 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb l\u1ee3i ti\u1ec3u. Vai tr\u00f2 c\u1ee7a thi\u1ebft b\u1ecb c\u1ea3m \u1ee9ng \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u1ea5y \u0111\u01b0\u1ee3c c\u1ee7a c\u00f4ng ty Abbott \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e1nh g\u00e1i trong th\u1eed nghi\u1ec7m CHAMPION. K\u1ebft qu\u1ea3 cho th\u1ea5y chi\u1ebfn l\u01b0\u1ee3c ch\u0103m s\u00f3c d\u1ef1a tr\u00ean thi\u1ebft b\u1ecb \u0111o l\u01b0\u1eddng \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m c\u00f3 \u00fd ngh\u0129a t\u1ef7 l\u1ec7 nh\u1eadp vi\u1ec7n do suy tim, k\u1ec3 c\u1ea3 b\u1ec7nh nh\u00e2n c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i \u2265 40%. M\u1ed9t s\u1ed1 thi\u1ebft b\u1ecb kh\u00e1c trong ki\u1ec3m so\u00e1t suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n nh\u01b0 thi\u1ebft b\u1ecb ph\u00e2n t\u00edch th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n, c\u00f4ng c\u1ee5 th\u00f4ng v\u00e1ch li\u00ean nh\u0129, \u0111\u1ed1t th\u1ea7n kinh t\u1ea1ng ho\u1eb7c thi\u1ebft b\u1ecb \u0111i\u1ec1u bi\u1ebfn co b\u00f3p tim \u0111\u1ec1u \u0111ang \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1, hi\u1ec7u l\u1ef1c c\u1ee7a nh\u1eefng thi\u1ebft b\u1ecb n\u00e0y v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c l\u00e0m s\u00e1ng t\u1ecf<sup>12<\/sup>.<\/p>\n\n\n\n<p><strong>Ki\u1ec3m so\u00e1t b\u1ec7nh m\u1eafc k\u00e8m<\/strong><\/p>\n\n\n\n<p>Chi\u1ebfn l\u01b0\u1ee3c ki\u1ec3m so\u00e1t b\u1ec7nh m\u1eafc k\u00e8m \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n trong h\u00ecnh 3.<\/p>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-134e7b48f68f0e97e7afda74994c53ce.png\"><strong>H\u00ecnh 3.&nbsp;<\/strong>Chi\u1ebfn l\u01b0\u1ee3c ki\u1ec3m so\u00e1t b\u1ec7nh m\u1eafc k\u00e8m \u1edf b\u1ec7nh nh\u00e2n suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\" \/>\n\n\n\n<p><strong>T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Kittleson MM, Panjrath GS, Amancherla K, Davis LL, Deswal A, Dixon DL, Januzzi JL Jr, Yancy CW. 2023 ACC Expert Consensus Decision Pathway on Management of Heart Failure With Preserved Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2023 May 9;81(18):1835-1878. doi: 10.1016\/j.jacc.2023.03.393.<\/li>\n\n\n\n<li>Shah KS, Xu H, Matsouaka RA, et al. Heart failure with preserved, borderline, and reduced ejection fraction: 5 year outcomes. J Am Coll Cardiol. 2017;70:2476\u20132486.<\/li>\n\n\n\n<li>Bozkurt B, Coats AJ, Tsutsui H, et al. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure. J Card Fail. Published online February 7, 2021. https:\/\/doi.org\/10.1016\/j.cardfail.2021.01.022<\/li>\n\n\n\n<li>McKee PA, Castelli WP, McNamara PM, et al. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971;285:1441<\/li>\n\n\n\n<li>Logeart D, Saudubray C, Beyne P, et al. Comparative value of doppler echocardiography and B-type natriuretic peptide assay in the etiologic diagnosis of acute dyspnea. J Am Coll Cardiol. 2002;40:1794-1800.<\/li>\n\n\n\n<li>Jayaraj A, Raju S, May C, et al. The diagnostic unreliability of classic physical signs of lymphedema. J Vasc Surg Venous Lymphat Disord. 2019;7:890 897.<\/li>\n\n\n\n<li>Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387: 1089\u20131098.<\/li>\n\n\n\n<li>Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385:1451\u20131461.<\/li>\n\n\n\n<li>Voors AA, Angermann CE, Teerlink JR, et al. The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial. Nat Med. 2022;28:568\u2013574<\/li>\n\n\n\n<li>Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved trial. Lancet. 2003;362:777\u2013781<\/li>\n\n\n\n<li>Massie BM, Carson PE, McMurray JJ, et al. Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med. 2008;359:2456\u20132467<\/li>\n\n\n\n<li>Abraham WT, Adamson PB, Bourge RC, et al. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet. 2011;377:658\u2013666.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>M\u1eb7c d\u00f9 c\u00f3 nhi\u1ec1u ti\u1ebfn b\u1ed9 trong \u0111i\u1ec1u tr\u1ecb, suy tim v\u1eabn l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh m\u1eafc k\u00e8m v\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u1eed vong h\u00e0ng \u0111\u1ea7u th\u1ebf gi\u1edbi. \u1ede Hoa K\u1ef3 n\u00f3i ri\u00eang, m\u1eb7c d\u00f9 t\u1ef7 l\u1ec7 m\u1eafc suy tim nh\u00ecn chung gi\u1ea3m, nh\u01b0ng t\u1ef7 l\u1ec7 m\u1eafc suy tim ph\u00e2n su\u1ea5t m\u00e1u b\u1ea3o t\u1ed3n &hellip;<\/p>\n<p class=\"read-more\"> <a class=\"\" href=\"https:\/\/docquity.com\/vi\/articles\/acc-2023-huong-dan-kiem-soat-suy-tim-phan-suat-tong-mau-bao-ton\/\"> <span class=\"screen-reader-text\">ACC 2023: H\u01b0\u1edbng d\u1eabn ki\u1ec3m so\u00e1t suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n<\/span> Read More &raquo;<\/a><\/p>\n","protected":false},"author":123,"featured_media":12700,"comment_status":"closed","ping_status":"closed","template":"","meta":{"content-type":"","inline_featured_image":false,"site-sidebar-layout":"default","site-content-layout":"default","ast-global-header-display":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","footnotes":""},"articles_categories":[1370],"articles_tags":[],"articles_topics":[1439],"articles_languages":[1375],"articles_filters":[],"class_list":["post-12692","articles","type-articles","status-publish","has-post-thumbnail","hentry","articles_categories-medical-content-vi","articles_languages-vietnamese-vi"],"_links":{"self":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/12692","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles"}],"about":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/types\/articles"}],"author":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/users\/123"}],"replies":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/comments?post=12692"}],"version-history":[{"count":0,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/12692\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media\/12700"}],"wp:attachment":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media?parent=12692"}],"wp:term":[{"taxonomy":"articles_categories","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_categories?post=12692"},{"taxonomy":"articles_tags","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_tags?post=12692"},{"taxonomy":"articles_topics","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_topics?post=12692"},{"taxonomy":"articles_languages","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_languages?post=12692"},{"taxonomy":"articles_filters","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_filters?post=12692"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}