Ukukhutshwa kwe-ventricular yasekhohlo kunye ne-Impella kwimizuzu ye-30 ngaphambi kokuba i-PCI idibaniswe nokunciphisa ubungakanani be-infarct kwizigulane ze-STEMI.

I risultati di una nuova analisi per protocollo dei dati dello studio pilota ST-segment Elevation Myocardial Infarction Door-To-Unload (STEMI DTU) mostrano una dimensione significativamente ridotta dell’infarto nei pazienti sottoposti a scarico del ventricolo sinistro (VS) con Impella CP. Per 30 minuti prima di un intervento coronarico percutaneo (PCI) rispetto ai pazienti sottoposti a scarico VS immediatamente seguito da PCI. I dati sono stati presentati oggi nel corso della 2022 Transcatheter Cardiovascular Therapeutics (TCT) conference di Boston dal Dr. Navin K. Kapur, direttore esecutivo del Cardiovascular Center for Research and Innovation (CVCRI) del Tufts Medical Center nonché ricercatore principale dello studio pivot randomizzato e controllato STEMI DTU.

Ithini ingqiqo yolingo lokulinga lwe-STEMI DTU? (ukusuka kubasebenzi bomhleli)

Nangona ukwehla okukhulu kokufa ngenxa ye-acute myocardial infarction (AMI) ukususela ngo-1960, kukho ukunyuka okuhambelanayo kwimeko yokungaphumeleli kwentliziyo. Uhlalutyo oludityanisiweyo lwenqanaba lesigulane kwi-10 izilingo ezingabonakaliyo zibonise ukuba ubukhulu be-infarct bunxulumene kakhulu nokufa, kunye nokulaliswa esibhedlele ngenxa yokungaphumeleli kwentliziyo ngexesha lokulandelwa kwe-1 ngonyaka (Umfanekiso 1). Ngoko ke, kukho imfuno ebalulekileyo yeklinikhi yokungenelela okunokunciphisa umonakalo we-myocardial ngexesha le-myocardial infarction.

Braunwald et al. ngo-1971 wacebisa ukuba "imilinganiselo eyenzelwe ukunciphisa imfuno ye-oksijini ye-myocardial kunye nokuphucula ukuchithwa kwe-coronary, ukuba iphunyezwe ngokukhawuleza, inokunciphisa ubukhulu bokugqibela be-infarction (myocardial)." Ukusukela ngo-1978, uphononongo oluninzi lwangaphambi kweklinikhi luphande ukuba kuyancitshiswa ukusetyenziswa kweoksijini ye-myocardial ngokuphumeza impompo yokujikeleza komda womonakalo we-myocardial kwi-IMA. Izifundo eziye zavavanya ukukhutshwa komatshini usebenzisa izixhobo zomatshini zibonise ukuba ukukhutshwa kwangaphambili, kungekhona emva kokuphindaphinda, kuyimfuneko ukunciphisa ubungakanani bentliziyo.

kutshanje

Izifundo zangaphambi kweklinikhi zibonelele ngengqiqo kwiinkqubo apho ukukhutshwa kwe-ventricle ekhohlo yipompo ye-Impella® ye-cardiac kunciphisa umonakalo we-myocardial.

Kwi-2015, usebenzisa imodeli yehagu evela kwi-AMI, Kapur et al. Ubonise ukuba okokuqala kukhupha i-ventricle yasekhohlo usebenzisa i-Impella CP® kwaye emva koko kulibazise ukuphinda kufakwe kwakhona imizuzu engama-60. Ziye zafunyaniswa zikhokelela ekunciphiseni kwe-ventricular ye-ventricular ye-ventricular ethetha uxinzelelo lwe-parietal kunye ne-peak parietal stress ngokumalunga nokuphindaphinda ngokukhawuleza. Enyanisweni, ubungakanani bokunciphisa uxinzelelo lwendonga lwaluhambelana ngokuthe ngqo kwinqanaba lokunciphisa i-infarct ngobukhulu. Ngapha koko, uphononongo lubonise ukuba ukukhutshwa kwe-ventricular ekhohlo kunye nokulibaziseka kwakhona kusebenze inkqubo ye-cardioprotective signaling system eyanciphisa ukufa kweeseli kwaye yakhokelela ekunciphiseni kwe-43% kwisayizi ye-myocardial infarction.

Inye et al. ihlolisise imiphumo yepompo yentliziyo ye-Impella LD® efakwe ngotyando kwi-left ventricular remodeling kunye nomsebenzi we-1 inyanga emva kwe-infarction kwimodeli ye-porcine. Ukulayishwa kwe-ventricular ekhohlo, kunye ne-Impella LD, yaqaliswa imizuzu ye-30 ngaphambi kokuba i-reperfusion kunye nenkxaso igcinwe ukuya kuthi ga kwi-120 imizuzu emva kokuhlaziywa kwakhona. Ukukhutshwa kwe-ventricular yasekhohlo kubangele uxinzelelo lwe-ventricular esezantsi kunye noxinzelelo lwendonga kunye noxinzelelo oluphezulu lwe-arterial kunye nesiphumo senhliziyo. Okubalulekileyo, kwi-1 inyanga yokulandelelana, ubungakanani be-infarct kwiingulube ezikhutshwe i-LV zancitshiswa nge-50%. Ngokusekelwe kwezi ziphumo, ababhali baphetha ukuba ukunakekelwa kwangaphambili kunye ne-Impella LD kwi-IMA ukulungiswa okulinganiselweyo kwe-ventricle yasekhohlo, ngaloo ndlela kuphuculwe i-prognosis.

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