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Izizathu eziphambili zokufa ngenxa yesifo senhliziyo ziquka ukungaphumeleli kwentliziyo kunye ne-arrhythmias embi ebangelwa yi-ventricular fibrillation. Iziphumo ezivela kulingo lwe-RAFT, olupapashwe kwi-NEJM kwi-2010, lubonise ukuba ukudibanisa kwe-cardioverter defibrillator (ICD) efakwe kwi-implantable (ICD) kunye nonyango oluchanekileyo lweziyobisi kunye ne-cardiac resynchronization (CRT) yanciphisa kakhulu umngcipheko wokufa okanye ukulaliswa esibhedlele ngenxa yokungaphumeleli kwentliziyo. Nangona kunjalo, ngeenyanga ze-40 kuphela zokulandelelana ngexesha lokupapashwa, ixabiso lexesha elide lesi sicwangciso sonyango alicaci.

Ngokunyuka kwonyango olusebenzayo kunye nokwandiswa kwexesha lokusetyenziswa, ukuphumelela kweklinikhi yezigulane ezine-ejection ephantsi yokungaphumeleli kwentliziyo kuye kwaphuculwa. Ulingo olulawulwa ngokungakhethiyo luvavanya ukusebenza konyango ixesha eliqingqiweyo, kwaye ukusebenza kwalo kwexesha elide kunokuba nzima ukuvavanywa emva kokuba ulingo luphelile ngenxa yokuba izigulane ezikwiqela lolawulo zinokuwela ziye kwiqela lolingo. Kwelinye icala, ukuba unyango olutsha luyaphononongwa kwizigulana ezinentliziyo eyomileyo, ukusebenza kwalo kunokubonakala ngokukhawuleza. Nangona kunjalo, ukuqala unyango kwangoko, ngaphambi kokuba iimpawu zokungaphumeleli kwentliziyo zibe nzima kakhulu, kunokuba neempembelelo ezintle kakhulu kwiziphumo kwiminyaka emva kokuphela kovavanyo.

I-RAFT (I-Resynchronisation-Defibrillation Trial Therapy in Ambed Heart Failure), eyavavanya ukuphumelela kweklinikhi ye-cardiac resynchronisation (CRT), ibonise ukuba i-CRT yayisebenza kakhulu kwi-New York Heart Society (NYHA) i-Class II ye-heart failure izigulane: kunye nokulandelwa okuqhelekileyo kweenyanga ze-40 kunye ne-CRT yanciphisa ukufa kwezigulane ezinentliziyo. Emva kokulandelwa okuphakathi kweminyaka ephantse ibe yi-14 kumaziko asibhozo anenani elikhulu lezigulane ezibhalisiweyo kwilingo le-RAFT, iziphumo zibonise ukuphuculwa okuqhubekayo ekusindeni.

Kulingo olubalulekileyo olubandakanya izigulane ezine-NYHA grade III okanye i-ambulate grade IV yokungaphumeleli kwentliziyo, i-CRT iyancipha iimpawu, ukuphuculwa kwamandla okusebenza, kunye nokunciphisa ukulaliswa esibhedlele. Ubungqina obuvela kwintliziyo elandelayo Ukuvumelanisa kwakhona - Ukungaphumeleli kweNtliziyo (i-CARE-HF) ibonise ukuba izigulane ezifumene i-CRT kunye neyeza eziqhelekileyo (ngaphandle kwe-cardioverter defibrillator ye-implantable [ICD]) ziphila ixesha elide kunezo zafumana iyeza zodwa. Ezi zilingo zibonise ukuba i-CRT yanciphisa ukubuyiswa kwe-mitral kunye nokulungiswa kwentliziyo, kunye nokuphuculwa kweqhekeza le-ventricular ejection fraction. Nangona kunjalo, inzuzo yeklinikhi ye-CRT kwizigulane ezine-NYHA yeBanga lesi-II lokungaphumeleli kwentliziyo ihlala iphikisana. Kuze kube yi-2010, iziphumo ezivela kulingo lwe-RAFT zibonise ukuba izigulane ezifumana i-CRT ngokudibanisa ne-ICD (CRT-D) zinezinga elingcono lokusinda kunye nezibhedlele ezimbalwa kunezo zifumana i-ICD yodwa.

Idatha yakutshanje ibonisa ukuba ukuhamba ngokuthe ngqo kwingingqi yesebe ye-bundle ekhohlo, endaweni yokubeka i-CRT ikhokelela kwi-coronary sinus, inokuvelisa iziphumo ezilinganayo okanye ezingcono, ngoko ke intshiseko yonyango lwe-CRT kwizigulane ezinentliziyo encinci ingaphakanyiswa ngakumbi. Ulingo oluncinci olusetyenziswayo olusebenzisa olu buchule kwizigulane ezinezibonakaliso ze-CRT kunye neqhezu le-ejection ye-ventricular ekhohlo engaphantsi kwe-50% ibonise amathuba amakhulu okufakelwa kwe-lead eyimpumelelo kunye nokuphuculwa okukhulu kwi-fraction ye-ventricular ejection fraction xa kuthelekiswa nezigulane ezifumene i-CRT eqhelekileyo. Ukulungiswa okungaphezulu kokuhamba okukhokelela kunye neeshethi ze-catheter kunokuphucula impendulo ye-physiological kwi-CRT kunye nokunciphisa umngcipheko weengxaki zotyando.

Kulingo lwe-SOLVD, izigulane ezineempawu zokungaphumeleli kwentliziyo ezithatha i-enalapril zaphila ixesha elide kunezo zathatha indawo ye-placebo ngexesha lovavanyo; Kodwa emva kweminyaka eyi-12 yokulandela, ukusinda kwiqela le-enalapril kuye kwehle ukuya kumanqanaba afana nalawo akwiqela le-placebo. Ngokwahlukileyo koko, phakathi kwezigulane ezine-asymptomatic, iqela le-enalapril lalingenakufane liphile kulingo lweminyaka emi-3 kuneqela le-placebo, kodwa emva kweminyaka eli-12 yokulandela, ezi zigulana zazinokwenzeka kakhulu ukuba ziphile kuneqela le-placebo. Ngokuqinisekileyo, emva kokuba ixesha lokuvavanya liphelile, i-ACE inhibitors yayisetyenziswa ngokubanzi.

Ngokusekelwe kwiziphumo ze-SOLVD kunye nezinye izilingo zokungaphumeleli kwentliziyo, izikhokelo zincoma ukuba amayeza okuhluleka kwentliziyo yempawu aqaliswe ngaphambi kokuba iimpawu zokungaphumeleli kwentliziyo zivele (inqanaba B). Nangona izigulane kulingo lwe-RAFT zineempawu ezincinci zokungaphumeleli kwentliziyo ngexesha lokubhalisa, phantse i-80 ekhulwini yafa emva kweminyaka eyi-15. Ngenxa yokuba i-CRT inokuphucula kakhulu ukusebenza kwentliziyo yezigulane, umgangatho wobomi, kunye nokuphila, umgaqo wokunyanga ukuhluleka kwentliziyo ngokukhawuleza unokubandakanya i-CRT, ngakumbi njengoko iteknoloji ye-CRT iphucula kwaye iba lula kwaye ikhuselekile ukuyisebenzisa. Kwizigulane ezineqhekeza elisezantsi le-ventricular ejection, akunakwenzeka ukuba kunyuswe i-fraction ye-ejection kunye neyeza zodwa, ngoko ke i-CRT inokuqaliswa ngokukhawuleza emva kokuxilongwa kwebhloko ye-bundle ye-bundle ekhohlo. Ukuchonga abaguli abane-asymptomatic ye-ventricular ye-ventricular engasebenzi kakuhle ngokujonga i-biomarker kunokunceda ukuqhubela phambili ukusetyenziswa konyango olusebenzayo olunokukhokelela ekuphileni ixesha elide, elikumgangatho ophezulu.

Kufuneka kuqatshelwe ukuba ukususela ekubeni iziphumo zokuqala zovavanyo lwe-RAFT zichazwe, kukho ukuqhubela phambili okuninzi kwi-pharmacological treatment of heart failure, kubandakanywa i-enkephalin inhibitors kunye ne-SGLT-2 inhibitors. I-CRT inokuphucula umsebenzi wenhliziyo, kodwa ayinyusi umthwalo wenhliziyo, kwaye kulindeleke ukuba idlale indima ehambelanayo kunyango lweziyobisi. Nangona kunjalo, isiphumo se-CRT kubomi bezigulane ezinyangwe ngechiza elitsha akuqinisekanga.