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El genotipo de la enzima convertidora de angiotensina modula la función pulmonar y la capacidad de ejercicio en
M Roselle Abraham1, Lyle J Olson, Michael J Joyner
1Division of Cardiovascular, Mayo Clinic and Foundation, Rochester, Minn 55905, USA.
Circulation
|October 3, 2002
Resumen
El genotipo DD de la enzima convertidora de angiotensina (ACE) está relacionado con una tolerancia reducida al ejercicio en pacientes con insuficiencia cardíaca congestiva (ICC). Esto puede deberse a una función pulmonar deteriorada, lo que sugiere que la inhibición dirigida de la ECA podría mejorar la capacidad de ejercicio.
Área de la Ciencia:
- Cardiología Cardiología.
- Genética La genética.
- Medicina Pulmonar La medicina pulmonar es el tratamiento de las enfermedades pulmonares.
Sus antecedentes:
- El polimorfismo del gen de la enzima convertidora de angiotensina (ACE) influye en la actividad de la ACE y en las sustancias vasoactivas.
- La disfunción pulmonar es común en la insuficiencia cardíaca congestiva (ICC), pero sus mecanismos no se comprenden completamente.
- La inhibición de la ECA puede mejorar el intercambio de gases y la capacidad de ejercicio en pacientes con ECH.
Objetivo del estudio:
- Investigar la asociación entre el genotipo de la ECA y la función pulmonar en pacientes tratados con ECH.
- Para determinar si el genotipo de la ECA se correlaciona con la intolerancia al ejercicio en pacientes con insuficiencia cardíaca congestiva.
Principales métodos:
- Se estudiaron 57 pacientes con CHF estratificados por el genotipo ACE (DD, ID, II).
- Se evaluó la función pulmonar, la fracción de eyección ventricular izquierda (LVEF), la actividad ACE y la angiotensina II en plasma.
- Pico evaluado del consumo de oxígeno (VO2) y el intercambio de gases durante el ejercicio graduado.
Principales resultados:
- No hay diferencias significativas en LVEF, función diastólica o presiones de la arteria pulmonar entre los genotipos.
- El genotipo ACE DD se asoció con una reducción significativa del pico VO2 y la capacidad vital forzada.
- Los homocigotos DD exhibieron una mayor actividad sérica de ACE, angiotensina II en plasma y equivalentes ventilatorios para el dióxido de carbono (VE / VCO2) durante el ejercicio.
Conclusiones:
- El genotipo ACE DD está relacionado con una disminución de la tolerancia al ejercicio en la insuficiencia cardíaca congestiva, potencialmente a través de una función pulmonar alterada.
- Las estrategias para una inhibición más completa de la ECA o potenciación de la bradicinina pueden mejorar la capacidad de ejercicio en pacientes con CHF con genotipo DD.
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