nkhani

Zomwe zimayambitsa imfa kuchokera ku matenda a mtima zimaphatikizapo kulephera kwa mtima ndi matenda oopsa a arrhythmia omwe amayamba chifukwa cha ventricular fibrillation. Zotsatira za mayesero a RAFT, omwe adafalitsidwa mu NEJM mu 2010, adawonetsa kuti kuphatikiza kwa implantable cardioverter defibrillator (ICD) kuphatikizapo mankhwala abwino kwambiri a mankhwala ndi cardiac resynchronization (CRT) kuchepetsa kwambiri chiopsezo cha imfa kapena kuchipatala chifukwa cha kulephera kwa mtima. Komabe, ndi miyezi ya 40 yokha yotsatiridwa panthawi yofalitsidwa, phindu la nthawi yayitali la njira ya chithandizoyi silikudziwika bwino.

Ndi kuwonjezeka kwa chithandizo chamankhwala komanso nthawi yowonjezera yogwiritsira ntchito, mphamvu yachipatala ya odwala omwe ali ndi kagawo kakang'ono ka ejection mtima kulephera kwakhala bwino. Mayesero olamulidwa mwachisawawa nthawi zambiri amayesa mphamvu ya chithandizo kwa nthawi yochepa, ndipo mphamvu yake ya nthawi yayitali ikhoza kukhala yovuta kuyesa mayeserowo atatha chifukwa odwala omwe ali mu gulu lolamulira akhoza kuwolokera ku gulu loyesa. Kumbali ina, ngati chithandizo chatsopano chikuphunziridwa kwa odwala omwe ali ndi vuto la mtima, mphamvu yake ingawonekere posachedwa. Komabe, kuyamba chithandizo mwamsanga, zizindikiro za kulephera kwa mtima zisanakhale zovuta kwambiri, zingakhale ndi zotsatira zabwino kwambiri pa zotsatira zaka pambuyo poyesa kutha.

The RAFT (Resynchronisation-Defibrillation Therapy Trial in Ambed Heart Failure), yomwe inayesa mphamvu yachipatala ya resynchronisation ya mtima (CRT), inasonyeza kuti CRT inali yothandiza kwambiri ku New York Heart Society (NYHA) Class II odwala matenda a mtima: ndi kutsata kwapakati kwa miyezi 40, CRT inachepetsa imfa ya odwala omwe ali ndi mtima wamtima. Pambuyo pakutsatiridwa kwapakati kwa zaka pafupifupi 14 m'malo asanu ndi atatu omwe ali ndi chiwerengero chachikulu cha odwala omwe analembetsa muyeso la RAFT, zotsatira zinasonyeza kupititsa patsogolo kupulumuka.

M'mayesero ofunika kwambiri okhudza odwala omwe ali ndi NYHA grade III kapena ambulate grade IV kulephera kwa mtima, CRT inachepetsa zizindikiro, kupititsa patsogolo masewera olimbitsa thupi, komanso kuchepetsa kugonekedwa kuchipatala. Umboni wochokera kumtima wotsatira Resynchronization - Heart Failure (CARE-HF) mayesero amasonyeza kuti odwala omwe adalandira CRT ndi mankhwala ovomerezeka (popanda implantable cardioverter defibrillator [ICD]) adapulumuka nthawi yayitali kuposa omwe adalandira mankhwala okha. Mayeserowa adawonetsa kuti CRT idachepetsera mitral regurgitation ndi kukonzanso mtima, komanso kuwongolera kagawo kakang'ono ka kumanzere kwa ventricular ejection. Komabe, phindu lachipatala la CRT kwa odwala omwe ali ndi vuto la mtima la NYHA Grade II limakhala lotsutsana. Mpaka 2010, zotsatira za mayesero a RAFT zinasonyeza kuti odwala omwe amalandira CRT pamodzi ndi ICD (CRT-D) anali ndi moyo wabwino komanso zipatala zochepa kuposa omwe amalandira ICD okha.

Deta yaposachedwa ikuwonetsa kuti kuyenda kwachindunji m'dera la nthambi yakumanzere, m'malo moyika CRT kumatsogolera kudzera mucoronary sinus, kumatha kubweretsa zotsatira zofanana kapena zabwinoko, kotero chidwi cha chithandizo cha CRT kwa odwala omwe ali ndi vuto lochepa la mtima chikhoza kukulirakulira. Mayesero ang'onoang'ono omwe amagwiritsira ntchito njirayi kwa odwala omwe ali ndi zizindikiro za CRT ndi gawo lamanzere la ejection lamanzere la 50% linasonyeza mwayi wochuluka wa kupititsa patsogolo kutsogolo komanso kusintha kwakukulu kwa gawo lamanzere la ejection poyerekeza ndi odwala omwe adalandira CRT wamba. Kukhathamiritsa kwina kwa ma pacing lead ndi ma catheter sheaths amatha kusintha kuyankha kwa thupi ku CRT ndikuchepetsa chiopsezo cha zovuta za opaleshoni.

Mu mayesero a SOLVD, odwala omwe ali ndi zizindikiro za kulephera kwa mtima omwe adatenga enalapril adapulumuka nthawi yayitali kuposa omwe adatenga placebo panthawi ya mayesero; Koma pambuyo pa zaka 12 zotsatiridwa, kupulumuka mu gulu la enalapril kunatsika kufika pamlingo wofanana ndi wa gulu la placebo. Mosiyana ndi zimenezi, pakati pa odwala asymptomatic, gulu la enalapril silinathenso kupulumuka mayesero a zaka 3 kuposa gulu la placebo, koma pambuyo pa zaka 12 zotsatila, odwalawa anali okhoza kupulumuka kuposa gulu la placebo. Zachidziwikire, nthawi yoyeserera itatha, zoletsa za ACE zidagwiritsidwa ntchito kwambiri.

Malingana ndi zotsatira za SOLVD ndi mayesero ena ochititsa chidwi a mtima, malangizo amalimbikitsa kuti mankhwala azizindikiro za kulephera kwa mtima ayambe zizindikiro za kulephera kwa mtima zisanawonekere (gawo B). Ngakhale kuti odwala mu mayesero a RAFT anali ndi zizindikiro zochepa chabe za kulephera kwa mtima panthawi yolembetsa, pafupifupi 80 peresenti anamwalira patatha zaka 15. Chifukwa CRT ikhoza kupititsa patsogolo ntchito ya mtima wa odwala, moyo wabwino, ndi kupulumuka, mfundo yochizira kulephera kwa mtima mwamsanga ingaphatikizepo CRT, makamaka pamene luso la CRT likukula ndikukhala losavuta komanso lotetezeka kugwiritsa ntchito. Kwa odwala omwe ali ndi kachigawo kakang'ono ka kumanzere kwa ventricular ejection, sikutheka kuwonjezera kagawo kakang'ono ka ejection ndi mankhwala okha, kotero CRT ikhoza kuyambitsidwa mwamsanga pambuyo pozindikira kuti pali chipika cha nthambi yakumanzere. Kuzindikiritsa odwala omwe ali ndi vuto la ventricular kumanzere kwa asymptomatic kudzera pakuwunika kwa biomarker kungathandize kupititsa patsogolo kugwiritsa ntchito njira zochiritsira zomwe zingayambitse kupulumuka kwautali, wapamwamba kwambiri.

Tiyenera kuzindikira kuti kuyambira pamene zotsatira zoyamba za mayesero a RAFT zidanenedwa, pakhala pali zambiri zomwe zikupita patsogolo pa chithandizo chamankhwala cha mtima, kuphatikizapo enkephalin inhibitors ndi SGLT-2 inhibitors. CRT ikhoza kupititsa patsogolo ntchito ya mtima, koma sikuwonjezera kuchuluka kwa mtima, ndipo ikuyembekezeka kuchitapo kanthu pa chithandizo chamankhwala. Komabe, zotsatira za CRT pa moyo wa odwala omwe amathandizidwa ndi mankhwala atsopano sizikudziwika.