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La reducción de la irregularidad de la respuesta ventricular se asocia con un aumento de la mortalidad en pacientes
1Third Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Japan. a.yamada@med.nagoya-cu.ac.jp
Circulation
|July 19, 2000
Resumen
La reducción de la irregularidad del intervalo de respuesta ventricular (IRV) durante la fibrilación auricular (FA) predice la muerte cardíaca. La menor irregularidad del IRV indica un mayor riesgo de mortalidad en pacientes con FA, destacando su valor pronóstico.
Área de la Ciencia:
- Cardiología Cardiología.
- Ingeniería Biomédica Ingeniería Biomédica.
- Electrofisiología Clínica Electrofisiología Clínica.
Sus antecedentes:
- Las variaciones del intervalo de respuesta ventricular (IRV) en la fibrilación auricular (FA) pueden estar relacionadas con resultados adversos.
- Significado pronóstico de la dinámica VRI en AF sigue sin estar claro.
Objetivo del estudio:
- Investigar el valor pronóstico de la variabilidad e irregularidad del IRV para los resultados clínicos en pacientes con FA crónica.
Principales métodos:
- Se analizaron ECGs ambulatorios de 24 horas de 107 pacientes con FA crónica.
- Variabilidad VRI evaluada (SD, SD de diferencias sucesivas, SD de promedios de 5 minutos) y irregularidad (entropía de Shannon, dinámica simbólica, entropía aproximada [ApEn(b-b), ApEn(m-m) ]).
- Medidas correlacionadas de IRV con muerte cardíaca, accidente cerebrovascular fatal y mortalidad por cualquier causa durante 33 meses de seguimiento.
Principales resultados:
- La reducción de la variabilidad del IRV y las medidas de irregularidad se correlacionaron con un mayor riesgo de muerte cardíaca.
- Las medidas de irregularidad del IRV (entropía de Shannon, ApEn) predijeron de manera independiente la mortalidad cardíaca después de ajustar la fracción de eyección y la FA isquémica.
- Los valores más bajos de ApEn(b-b) mostraron un gradiente significativo en las tasas de mortalidad cardíaca a 5 años (0% frente a 13% frente a 43%).
Conclusiones:
- La reducción de la irregularidad del IRV en el ECG de 24 horas es un predictor independiente de la mortalidad cardíaca en la FA crónica.
- El análisis de irregularidades de IRV ofrece información pronóstica valiosa para el manejo de pacientes con AF.
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