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El papel pronóstico del deterioro del flujo sanguíneo del miocardio en la disfunción idiopática del ventrículo

Danilo Neglia¹, Claudio Michelassi, Maria Giovanna Trivieri

¹C.N.R. Institute of Clinical Physiology, Pisa, Italy. dneglia@ifc.pi.cnr.it

|January 16, 2002

Resumen

La reducción del flujo sanguíneo miocárdico (FMB) predice malos resultados en pacientes con disfunción ventricular izquierda idiopática. Este hallazgo es independiente de la fracción de eyección o la gravedad de la insuficiencia cardíaca, destacando la FMB como un marcador pronóstico clave.

Área de la Ciencia:

Cardiología Cardiología.
Imágenes cardiovasculares por imágenes.
Cardiología Nuclear Cardiología nuclear.

Sus antecedentes:

La miocardiopatía dilatada se asocia con una reducción del flujo sanguíneo miocárdico (FMB).
La importancia pronóstica del deterioro de la MBF en la disfunción idiopática del ventrículo izquierdo (LV) requiere una mayor investigación.

Objetivo del estudio:

Determinar si el deterioro de la FMB es un predictor independiente del pronóstico en pacientes con disfunción idiopática de LV.

Principales métodos:

Inscripción prospectiva de 67 pacientes con disfunción sistólica LV idiopática.
Evaluación del estado clínico y funcional, incluida la fracción de eyección de LV.
Tomografía por emisión de positrones (PET) para medir el MBF absoluto en reposo y durante el estrés dipiridamólico.

Principales resultados:

Durante un seguimiento promedio de 45 meses, 24 pacientes experimentaron eventos cardíacos mayores.
El análisis multivariado identificó la frecuencia cardíaca, la dimensión diastólica final de LV y el MBF de dipiridamolo como predictores independientes de eventos cardíacos.
El dipiridamolo MBF severamente deprimido (<= 1,36 mL / min / g) aumentó el riesgo de muerte o progresión de insuficiencia cardíaca en 3,5 veces.

Conclusiones:

La FMB severamente deprimida es un predictor significativo de mal pronóstico en la disfunción idiopática de LV.
Este valor predictivo es independiente del deterioro funcional de LV y la presencia de insuficiencia cardíaca manifiesta.
La medición de MBF ofrece información pronóstica valiosa en esta población de pacientes.

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