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Respuestas respiratorias y de ritmo cardíaco al ejercicio: mejores predictores de la mortalidad por insuficiencia
M Robbins1, G Francis, F J Pashkow
1George M. and Linda Kaufman Center for Heart Failure, Desk F25, Department of Cardiology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Circulation
|December 14, 1999
Resumen
Las respuestas anormales al ejercicio, incluida una alta respuesta ventilatoria (VE / VCO2) y un bajo índice cronotrópico, predicen la mortalidad por insuficiencia cardíaca. Estos indicadores clave ayudan a identificar pacientes de alto riesgo para una mejor gestión.
Área de la Ciencia:
- Cardiología Cardiología.
- Fisiología del ejercicio Fisiología del ejercicio
Sus antecedentes:
- La insuficiencia cardíaca severa a menudo se presenta con respuestas cronotrópicas y ventilatorias anormales durante el ejercicio.
- El valor pronóstico comparativo de estas respuestas sigue siendo poco explorado.
Objetivo del estudio:
- Investigar el valor predictivo independiente de las respuestas cronotrópicas y ventilatorias inducidas por el ejercicio para la mortalidad en pacientes con insuficiencia cardíaca.
- Para determinar si estas respuestas pueden estratificar el riesgo de insuficiencia cardíaca.
Principales métodos:
- Una cohorte de 470 pacientes con insuficiencia cardíaca (sin betabloqueantes o inotrópicos) se sometió a pruebas de estrés metabólico.
- Se midieron el índice cronotrópico, el consumo máximo de oxígeno (VO2) y la respuesta ventilatoria (VE / VCO2).
- Los pacientes fueron seguidos durante 1,5 años para los resultados de mortalidad.
Principales resultados:
- Los pacientes con insuficiencia cardíaca presentaron respuestas respiratorias y cronotrópicas significativamente anormales en comparación con los controles sanos.
- El análisis univariado identificó alta VE / VCO2, bajo índice cronotrópico, bajo VO2, baja presión arterial y mayor edad como predictores de mortalidad.
- El análisis multivariado confirmó un alto índice VE/VCO2 (RR 3.20) y un bajo índice cronotrópico (RR 1.94) como predictores independientes de la muerte.
Conclusiones:
- Las respuestas respiratorias y cronotrópicas del ejercicio son predictores potentes e independientes de la mortalidad por insuficiencia cardíaca.
- Estas medidas fisiológicas son valiosas para la estratificación del riesgo en el manejo de la insuficiencia cardíaca.
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