Izimbangela eziyinhloko zokufa ngenxa yesifo senhliziyo zihlanganisa ukuhluleka kwenhliziyo kanye ne-arrhythmias eyingozi ebangelwa ukuphefumula kwe-ventricular. Imiphumela evela ocwaningweni lwe-RAFT, eyanyatheliswa ku-NEJM ngo-2010, yabonisa ukuthi inhlanganisela ye-cardioverter defibrillator (ICD) efakwe emlanjeni kanye nokwelashwa kwezidakamizwa okufanelekile nge-cardiac resynchronization (CRT) kunciphisa kakhulu ingozi yokufa noma ukulaliswa esibhedlela ngenxa yokuhluleka kwenhliziyo. Kodwa-ke, ngezinyanga ezingu-40 kuphela zokulandelela ngesikhathi sokushicilela, inani lesikhathi eside laleli su lokwelapha alicacile.
Ngokukhula kokwelashwa okuphumelelayo kanye nokwandiswa kwesikhathi sokusetshenziswa, ukusebenza kahle komtholampilo kweziguli ezinengxenye ephansi ye-ejection yokuhluleka kwenhliziyo kuye kwathuthukiswa. Izivivinyo ezilawulwa ngokungahleliwe ngokuvamile zihlola ukuphumelela kokwelashwa isikhathi esilinganiselwe, futhi ukusebenza kwayo kwesikhathi eside kungase kube nzima ukukuhlola ngemva kokuphela kokuhlolwa ngenxa yokuthi iziguli eziseqenjini elilawulayo zingawela ziye eqenjini lesilingo. Ngakolunye uhlangothi, uma ukwelashwa okusha kufundwa ezigulini ezinesifo senhliziyo esithuthukisiwe, ukusebenza kwakho kungase kubonakale ngokushesha. Kodwa-ke, ukuqala ukwelashwa kusenesikhathi, ngaphambi kokuba izimpawu zokuhluleka kwenhliziyo zibe nzima kakhulu, kungase kube nomthelela omuhle kakhulu emiphumeleni eminyakeni eminingi ngemva kokuphela kwesivivinyo.
I-RAFT (Resynchronisation-Defibrillation Therapy Trial in Ambed Heart Failure), eyahlola ukusebenza kahle komtholampilo kwe-cardiac resynchronisation (CRT), yabonisa ukuthi i-CRT yayisebenza kahle ezigulini eziningi ze-New York Heart Society (NYHA) ze-Class II zokuhluleka kwenhliziyo: ngokulandelwa okulinganiselwe kwezinyanga ze-40, i-CRT yehlisa ukushona kwenhliziyo. Ngemuva kokulandelwa okuphakathi kweminyaka engaba ngu-14 ezikhungweni eziyisishiyagalombili ezinenani elikhulu leziguli ezibhalisiwe esivivinyweni se-RAFT, imiphumela yabonisa ukuthuthukiswa okuqhubekayo ekusindeni.
Esivivinyweni esibalulekile esihilela iziguli ezine-NYHA grade III noma i-ambulete ye-ambulate grade IV yenhliziyo, i-CRT enciphise izimpawu, ukuvivinya umzimba okuthuthukisiwe, nokunciphisa ukulaliswa esibhedlela. Ubufakazi obuvela enhliziyweni eyalandela Ukuvumelanisa kabusha - Ukuhluleka Kwenhliziyo (CARE-HF) kubonisa ukuthi iziguli ezithole i-CRT kanye nemithi evamile (ngaphandle kwe-implantable cardioverter defibrillator [ICD]) zasinda isikhathi eside kunalezo ezithole imithi yodwa. Lezi zivivinyo zibonise ukuthi i-CRT yehlisa ukuvuselelwa kwe-mitral kanye nokulungiswa kabusha kwenhliziyo, futhi yathuthukisa ingxenye ye-ventricular ejection yesokunxele. Kodwa-ke, inzuzo yomtholampilo ye-CRT ezigulini ezine-NYHA Grade II yokuhluleka kwenhliziyo ihlala iyimpikiswano. Kuze kube ngu-2010, imiphumela yocwaningo lwe-RAFT ibonise ukuthi iziguli ezithola i-CRT ngokuhambisana ne-ICD (CRT-D) zazinamazinga angcono okusinda kanye nokulaliswa esibhedlela okumbalwa kunalabo abathola i-ICD kuphela.
Idatha yakamuva iphakamisa ukuthi ukuhamba okuqondile endaweni yegatsha yenqwaba yesokunxele, esikhundleni sokubekwa kwe-CRT kuholela e-coronary sinus, kungaveza imiphumela elinganayo noma engcono, ngakho-ke umdlandla wokwelashwa kwe-CRT ezigulini ezinokuhluleka kwenhliziyo okuncane ungase uthuthuke nakakhulu. Ukuhlolwa okuncane okungahleliwe kusetshenziswa le nqubo ezigulini ezinezinkomba ze-CRT kanye nengxenye ye-ventricular ejection yesokunxele engaphansi kuka-50% ibonise amathuba amakhulu okufakelwa okuholela okuphumelelayo kanye nokuthuthukiswa okukhulu engxenyeni yesokunxele ye-ejection uma kuqhathaniswa neziguli ezithole i-CRT evamile. Ukwenziwa ngcono okwengeziwe kokuhamba kokuhamba kanye nama-catheter sheaths kungathuthukisa impendulo ye-physiological ku-CRT futhi kunciphise ingozi yezinkinga zokuhlinzwa.
Ocwaningweni lwe-SOLVD, iziguli ezinezimpawu zokuhluleka kwenhliziyo ezathatha i-enalapril zasinda isikhathi eside kunalezo ezathatha i-placebo ngesikhathi sokuhlolwa; Kodwa ngemva kweminyaka engu-12 yokulandelela, ukusinda eqenjini le-enalapril kwehle kwafinyelela emazingeni afana nalawo aseqenjini le-placebo. Ngokuphambene, phakathi kweziguli ezingenazimpawu, iqembu le-enalapril lalingasenamathuba amaningi okuthi lisinde ekuhlolweni kweminyaka emi-3 kuneqembu le-placebo, kodwa ngemva kweminyaka engu-12 yokulandelela, lezi ziguli zazisemathubeni amaningi kakhulu okusinda kuneqembu le-placebo. Vele, ngemuva kokuphela kwesikhathi sesivivinyo, ama-ACE inhibitors asetshenziswa kakhulu.
Ngokusekelwe emiphumeleni ye-SOLVD nezinye izivivinyo eziphawulekayo zokuhluleka kwenhliziyo, imihlahlandlela incoma ukuthi imithi yokuhluleka kwenhliziyo ephawulekayo iqalwe ngaphambi kokuba kuvele izimpawu zokuhluleka kwenhliziyo (isigaba B). Nakuba iziguli esivivinyweni se-RAFT zinezimpawu ezincane kuphela zokuhluleka kwenhliziyo ngesikhathi sokubhalisa, cishe amaphesenti angu-80 afa ngemva kweminyaka engu-15. Ngenxa yokuthi i-CRT ingathuthukisa ngokuphawulekayo ukusebenza kwenhliziyo yeziguli, izinga lokuphila, nokuphila, isimiso sokwelapha ukuhluleka kwenhliziyo ngokushesha ngangokunokwenzeka manje singase sihlanganise ne-CRT, ikakhulukazi njengoba ubuchwepheshe be-CRT buthuthuka futhi buba lula futhi buphephe ukusetshenziswa. Ezigulini ezinengxenyana ephansi ye-ventricular ejection ephansi, mancane amathuba okuthi kwandiswe ingxenye ye-ejection ngemithi yodwa, ngakho-ke i-CRT ingaqalwa ngokushesha ngangokunokwenzeka ngemva kokuxilongwa kwebhulokhi yegatsha lesobunxele. Ukuhlonza iziguli ezinokungasebenzi kahle kwe-ventricular yesokunxele okungabonakali ngokuhlolwa kwe-biomarker kungasiza ekuqhubekiseni phambili ukusetshenziswa kwezindlela zokwelapha ezisebenzayo ezingaholela ekusindeni isikhathi eside, okusezingeni eliphezulu.
Kumele kuqashelwe ukuthi kusukela kubikwe imiphumela yokuqala yokuhlolwa kwe-RAFT, kuye kwaba nentuthuko eminingi ekwelapheni kwemithi yokuhluleka kwenhliziyo, kuhlanganise ne-enkephalin inhibitors kanye ne-SGLT-2 inhibitors. I-CRT ingathuthukisa ukusebenza kwenhliziyo, kodwa ayikhulisi umthwalo wenhliziyo, futhi kulindeleke ukuthi idlale indima ehambisanayo ekwelashweni kwezidakamizwa. Nokho, umthelela we-CRT ekusindeni kweziguli ezelashwa ngomuthi omusha awuqiniseki.
Isikhathi sokuthumela: Jan-27-2024