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Respuesta ventilatoria mejorada al ejercicio en pacientes con insuficiencia cardíaca crónica y apnea central del
Michael Arzt1, Martina Harth, Andreas Luchner
1Klinik und Poliklinik für Innere Medizin II, Universität Regensburg, Germany. michael.arzt@klinik.uni-regensburg.de
Circulation
|April 16, 2003
Resumen
En pacientes con insuficiencia cardíaca crónica, la apnea central del sueño está relacionada con un aumento de la respuesta ventilatoria durante el ejercicio. Esto sugiere que la quimiosensibilidad aumentada al CO2 es un mecanismo compartido para ambas condiciones.
Área de la Ciencia:
- Cardiología Cardiología.
- Pulmonología Pulmonología.
- Medicina del sueño Medicina del sueño.
Sus antecedentes:
- La apnea central del sueño (ASC) y la respuesta ventilatoria mejorada (inclinación VE / VCO2) son comunes en la insuficiencia cardíaca crónica (ICC).
- Ambas condiciones están asociadas con un mal pronóstico en pacientes con ECH.
- Se sospecha que la quimiosensibilidad aumentada al CO2 es un mecanismo común, pero la relación entre la CSA y la pendiente VE / VCO2 en CHF no está clara.
Objetivo del estudio:
- Investigar la relación entre la apnea central del sueño (ASC) y la respuesta ventilatoria al ejercicio (inclinación VE/VCO2) en pacientes con insuficiencia cardíaca crónica (ICC).
Principales métodos:
- Se compararon 20 pacientes con insuficiencia cardíaca congestiva con CSA clínicamente significativa (índice de apnea-hipopnea > o = 15) con 10 pacientes con insuficiencia cardíaca congestiva sin CSA.
- Utilizó pruebas de ejercicio cardiopulmonar para determinar la pendiente VE / VCO2 y la capacidad de ejercicio (pico VO2).
- Evaluación de la fracción de eyección ventricular izquierda (LVEF) y el índice de apnea-hipopnea (AHI).
Principales resultados:
- Los pacientes con y sin CSA no mostraron diferencias significativas en la capacidad de ejercicio (pico de VO2) o LVEF.
- El índice de apnea-hipopnea (IAH) no se correlacionó con el pico VO2 o LVEF.
- Se encontró una correlación positiva muy significativa entre la pendiente VE/VCO2 y el AHI (P<0,001).
- La pendiente VE / VCO2 fue significativamente más alta en pacientes con ECC con CSA en comparación con aquellos sin (29.7 vs. 24.9, P <0.001).
Conclusiones:
- Los pacientes con insuficiencia cardíaca congestiva con CSA exhiben una respuesta ventilatoria significativamente aumentada al ejercicio en comparación con aquellos sin CSA.
- La pendiente VE / VCO2, a diferencia del pico VO2 y LVEF, está fuertemente asociada con la gravedad de la CSA en CHF.
- Estos hallazgos apoyan la quimiosensibilidad aumentada al CO2 como un mecanismo fisiopatológico común subyacente tanto a la CSA como a la respuesta ventilatoria mejorada en CHF.
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