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Valor pronóstico de la respiración nocturna de Cheyne-Stokes en la insuficiencia cardíaca crónica
P A Lanfranchi1, A Braghiroli, E Bosimini
1Division of Cardiology, Department of Bioengineering, Salvatore Maugeri Foundation, IRCCS, Veruno, Italy. planfranchi@fsm.it
Circulation
|March 23, 1999
Resumen
La respiración de Cheyne-Stokes (RSC) es común en la insuficiencia cardíaca crónica (ICC) y está relacionada con malos resultados. El índice de apnea / hipopnea (AHI) predice la muerte cardíaca, identificando a los pacientes de alto riesgo.
Área de la Ciencia:
- Cardiología Cardiología.
- Medicina del sueño Medicina del sueño.
- Medicina Pulmonar La medicina pulmonar es el tratamiento de las enfermedades pulmonares.
Sus antecedentes:
- La respiración nocturna de Cheyne-Stokes (RCS) es frecuente en pacientes con insuficiencia cardíaca crónica (ICC).
- La RSC puede estar asociada con la activación del sistema nervioso simpático en la ECH.
Objetivo del estudio:
- Investigar la importancia pronóstica de la RSC en pacientes con insuficiencia cardíaca congestiva.
- Para determinar si la ocurrencia de CSR afecta la supervivencia de los pacientes con CHF.
Principales métodos:
- Sesenta y dos pacientes con CHF (LVEF ≤35%, clase NYHA II-III) se sometieron a evaluaciones clínicas, ecocardiográficas y de sueño completas.
- Los estudios de sueño evaluaron la RSC, cuantificada por el porcentaje de respiración periódica y el índice de apnea / hipopnea (AHI).
- El seguimiento tuvo una media de 28 meses para evaluar la mortalidad cardíaca.
Principales resultados:
- Quince pacientes murieron por causas cardíacas durante el seguimiento.
- Los no sobrevivientes exhibieron una clase NYHA más alta, un LVEF más bajo, aurículas más grandes y un pico VO2 reducido.
- Un AHI más alto y un mayor tiempo en la respiración periódica se asociaron significativamente con un aumento de la mortalidad cardíaca.
- El análisis multivariado identificó el AHI y el área auricular izquierda como predictores independientes de la muerte cardíaca.
Conclusiones:
- El índice de apnea / hipopnea (AHI) es un potente predictor independiente de mal pronóstico en pacientes estables con insuficiencia cardíaca congestiva.
- Un AHI ≥30/h proporciona información pronóstica adicional más allá de las medidas clínicas, ecocardiográficas y autónomas.
- Un AHI elevado y el tamaño de la aurícula izquierda identifican a los pacientes con insuficiencia cardíaca congestiva con un riesgo muy alto de eventos cardíacos fatales.
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