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Disfunción endotelial en pacientes con dolor en el pecho y arterias coronarias normales

A A Quyyumi¹, R O Cannon, J A Panza

¹Cardiology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892.

|December 1, 1992

Resumen

La disfunción endotelial microvascular puede causar una reducción de la reserva de vasodilatadores coronarios en pacientes con dolor en el pecho y arterias coronarias normales. Esta disfunción está relacionada con una dilatación dependiente del endotelio deteriorada, lo que contribuye a los síntomas anginales.

Área de la Ciencia:

Medicina Cardiovascular La medicina cardiovascular es una especialidad de la salud.
Fisiología Clínica Fisiología Clínica.
Investigación médica Investigación médica.

Sus antecedentes:

Algunos pacientes con dolor en el pecho y arterias coronarias normales presentan una respuesta vasodilatadora reducida.
Los mecanismos subyacentes de esta respuesta reducida siguen sin estar claros.
Este estudio investiga la disfunción endotelial microvascular como una causa potencial.

Objetivo del estudio:

Para determinar si la disfunción endotelial microvascular contribuye a la reducción de la reserva de vasodilatadores en pacientes con dolor en el pecho y arterias coronarias epicárdicas normales.
Para evaluar la relación entre la vasodilatación dependiente del endotelio y la independiente.
Para explorar los posibles factores que influyen en la respuesta vasodilatadora.

Principales métodos:

Se estudiaron 51 pacientes con dolor en el pecho y arterias coronarias normales.
La función microvascular coronaria se evaluó mediante el ritmo atrial rápido y las infusiones intracoronarias de acetilcolina.
La vasodilatación independiente del endotelio se midió con nitroprussida de sodio.

Principales resultados:

Se encontró una correlación significativa entre los cambios en la resistencia coronaria inducidos por la acetilcolina y el ritmo auricular (r = 0,68, p < 0,001).
Los pacientes con dilatación reducida durante el pacing también mostraron una dilatación reducida dependiente del endotelio con acetilcolina.
La vasodilatación con nitroprussida de sodio no fue significativamente diferente, lo que indica que el defecto no se debió a la disfunción del músculo liso.

Conclusiones:

La disfunción endotelial microvascular se asocia con una reducción de la vasodilatación en pacientes que experimentan dolor en el pecho a pesar de las arterias coronarias epicárdicas normales.
Esta disfunción endotelial puede ser la causa de la reducción de la reserva vasodilatadora y de los síntomas anginales en este grupo de pacientes.
Los hallazgos resaltan la importancia de evaluar la función microvascular en pacientes con enfermedad arterial coronaria no obstructiva.

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