amakuru

Impamvu nyamukuru zitera urupfu ziterwa n'indwara z'umutima zirimo kunanirwa k'umutima hamwe na arththmias mbi iterwa na fibrillation ya ventricular. Ibyavuye mu igeragezwa rya RAFT, byasohotse muri NEJM mu mwaka wa 2010, byagaragaje ko guhuza umutima wa defibrillator yatewe na cardioverter (ICD) hiyongereyeho imiti ivura imiti hamwe na resinchronisation yumutima (CRT) byagabanije cyane ibyago byo gupfa cyangwa kuba mu bitaro kubera kunanirwa k'umutima. Ariko, mugihe amezi 40 gusa yo gukurikiranwa mugihe cyo gutangaza, agaciro karambye kiyi ngamba yo kuvura ntisobanutse.

Hiyongereyeho uburyo bwiza bwo kuvura no kwagura igihe cyo gukoresha, imikorere yubuvuzi bw’abarwayi bafite ikibazo cyo kunanirwa k'umutima gacye. Ibigeragezo byateganijwe byemewe mubisanzwe bisuzuma imikorere yubuvuzi mugihe gito, kandi ingaruka zigihe kirekire zirashobora kugorana kubisuzuma nyuma yikigereranyo kirangiye kuko abarwayi bo mumatsinda yubugenzuzi bashobora kwambukira mumatsinda yikigereranyo. Ku rundi ruhande, niba ubushakashatsi bushya bwakozwe ku barwayi bafite ikibazo cyo kunanirwa k'umutima, imikorere yacyo irashobora kugaragara vuba. Ariko, gutangira kwivuza hakiri kare, mbere yuko ibimenyetso byo kunanirwa k'umutima bidakabije, birashobora kugira ingaruka nziza cyane kubisubizo nyuma yimyaka iburanisha rirangiye.

RAFT (Resynchronisation-Defibrillation Therapy Trial in Ambed Heart Failure), yasuzumye imikorere yubuvuzi bwa cardiac resynchronisation (CRT), yerekanye ko CRT yagize akamaro mu barwayi benshi b’umutima w’umutima wa New York (NYHA) mu cyiciro cya kabiri: hamwe n’ikigereranyo cy’amezi 40, CRT yagabanije impfu n’ibitaro ku barwayi bafite ikibazo cy’umutima. Nyuma yo gukurikiranwa hagati yimyaka 14 mu bigo umunani bifite umubare munini w’abarwayi banditswe mu igeragezwa rya RAFT, ibisubizo byagaragaje ko bikomeje gutera imbere mu mibereho.

Mu igeragezwa rikomeye ririmo abarwayi bafite icyiciro cya gatatu cya NYHA cyangwa ambulate yo mu cyiciro cya IV cyananiranye umutima, CRT yagabanije ibimenyetso, yongerera ubushobozi imyitozo ngororamubiri, kandi igabanya ibitaro. Ibimenyetso byatanzwe n'umutima wakurikiyeho Resynchronisation - Ikizamini cyo kunanirwa k'umutima (CARE-HF) cyerekanye ko abarwayi bahawe CRT n'imiti isanzwe (nta muti watewe na cardioverter defibrillator [ICD]) barokotse kurusha abahawe imiti bonyine. Igeragezwa ryerekanaga ko CRT yagabanije mitral no kugarura umutima, no kunoza igice cyo gusohora ibumoso. Nyamara, inyungu zivurwa na CRT kubarwayi bafite ikibazo cya NYHA Icyiciro cya kabiri cyumutima gikomeje kutavugwaho rumwe. Kugeza mu mwaka wa 2010, ibisubizo bivuye mu igeragezwa rya RAFT byagaragaje ko abarwayi bahabwa CRT bafatanije na ICD (CRT-D) bafite ubuzima bwiza bwo kubaho ndetse no mu bitaro bike ugereranyije n'abahawe ICD bonyine.

Amakuru aheruka kwerekana yerekana ko kwihuta mu gice cy’ibumoso cy’amashami, aho gushyira CRT biganisha kuri coronary sinus, bishobora gutanga umusaruro ungana cyangwa mwiza, bityo ishyaka ryo kuvura CRT ku barwayi bafite ikibazo cy’umutima ryoroheje rishobora kurushaho kwiyongera. Ikigeragezo gito giteganijwe ukoresheje ubu buhanga ku barwayi bafite ibimenyetso bya CRT hamwe n’igice cy’ibumoso cyo gusohora amashanyarazi kiri munsi ya 50% byerekanaga ko bishoboka cyane ko hashyirwaho uburyo bwiza bwo gutera no gutera imbere mu gice cy’ibumoso cy’ibumoso ugereranije n’abarwayi bakiriye CRT isanzwe. Kunoza uburyo bwiza bwo kwihuta hamwe na catheter sheaths birashobora kunoza imikorere ya CRT kandi bikagabanya ibyago byo kubagwa.

Mu igeragezwa rya SOLVD, abarwayi bafite ibimenyetso byo kunanirwa k'umutima bafashe enalapril barokotse kurenza abafashe umwanya mu gihe cy'iburanisha; Ariko nyuma yimyaka 12 yo gukurikirana, kurokoka mumatsinda ya enalapril byari byaragabanutse kurwego rusa nurwo mumatsinda ya placebo. Ibinyuranye na byo, mu barwayi badafite ibimenyetso, itsinda rya enalapril ntirishobora kurokoka igeragezwa ryimyaka 3 kurusha itsinda rya placebo, ariko nyuma yimyaka 12 yo gukurikirana, aba barwayi wasangaga barokoka kurusha itsinda rya placebo. Birumvikana ko nyuma yikigeragezo kirangiye, inhibitor za ACE zakoreshejwe cyane.

Hashingiwe ku bisubizo bya SOLVD hamwe n’ibindi bimenyetso byerekana kunanirwa k'umutima, umurongo ngenderwaho urasaba ko imiti yo kunanirwa k'umutima ibimenyetso itangira mbere yuko ibimenyetso byo kunanirwa k'umutima bigaragara (icyiciro B). Nubwo abarwayi bari mu igeragezwa rya RAFT bari bafite ibimenyetso byoroheje byo kunanirwa k'umutima mugihe cyo kwiyandikisha, hafi 80 ku ijana bapfuye nyuma yimyaka 15. Kuberako CRT ishobora kunoza cyane imikorere yumutima wabarwayi, ubuzima bwiza, nubuzima, ihame ryo kuvura kunanirwa k'umutima hakiri kare rishobora kuba ririmo CRT, cyane cyane ko ikoranabuhanga rya CRT ritera imbere kandi rikoroha kandi rikoreshwa neza. Ku barwayi bafite uduce duto duto two gusohora amashanyarazi, ntibishoboka kongera igice cyo gusohora hakoreshejwe imiti yonyine, bityo CRT irashobora gutangizwa vuba bishoboka nyuma yo gusuzuma indwara yibumoso. Kumenya abarwayi bafite ibimenyetso simusiga byibumoso bidafite imbaraga binyuze mugupima biomarker bishobora gufasha guteza imbere ikoreshwa ryubuvuzi bwiza bushobora gutuma umuntu abaho igihe kirekire.

Twabibutsa ko kuva ibisubizo byambere byikigereranyo cya RAFT byatangajwe, habaye iterambere ryinshi mubuvuzi bwa farumasi bwo kuvura umutima, harimo na enkephalin inhibitor na SGLT-2 inhibitor. CRT irashobora kunoza imikorere yumutima, ariko ntabwo yongera imitima yumutima, kandi biteganijwe ko izagira uruhare runini mukuvura imiti. Icyakora, ingaruka za CRT ku mibereho y’abarwayi bavuwe n’imiti mishya ntizwi.