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El aumento de la presión arterial diastólica por ejercicio como indicador de la disfunción ventricular izquierda
Lancet (London, England)
|April 13, 1991
Resumen
Un aumento en la presión arterial diastólica durante las pruebas de ejercicio puede indicar enfermedad arterial coronaria. Esta respuesta anormal puede identificar pacientes de alto riesgo que de otro modo podrían recibir resultados falsos negativos.
Área de la Ciencia:
- Cardiología Cardiología.
- Fisiología del ejercicio Fisiología del ejercicio
Sus antecedentes:
- La evaluación del dolor en el pecho y el infarto de miocardio (IM) a menudo implica pruebas de ejercicio.
- Las respuestas anormales durante las pruebas de estrés por ejercicio pueden indicar problemas cardiovasculares subyacentes.
Objetivo del estudio:
- Para investigar la importancia de un aumento de la presión arterial diastólica (BPD) durante las pruebas de ejercicio en pacientes con infarto de miocardio reciente o sospechoso.
- Para determinar si una respuesta anormal a la DBP está asociada con la enfermedad de las arterias coronarias e impacta en la función cardíaca después de la intervención.
Principales métodos:
- Análisis de 541 pacientes sometidos a pruebas de cinta de correr con síntomas limitados para dolor en el pecho o post-MI.
- Correlación de la respuesta de DBP con los hallazgos de isquemia electrocardiográfica (ECG) y angiografía coronaria.
- Evaluación de los cambios en la fracción de eyección ventricular izquierda (LVEF) después de la cirugía de derivación de la arteria coronaria (CABG) basada en la respuesta postoperatoria de DBP.
Principales resultados:
- El 16,8% de los pacientes (91/541) exhibió un aumento de >15 mm Hg en la DBP durante el ejercicio.
- Entre las personas con respuesta anormal a la DBP, 24 tenían estenosis arterial coronaria significativa (≥70% en ≥2 vasos) a pesar de no tener una depresión ST significativa en el ECG.
- Los pacientes con respuesta posoperatoria normal a la DBP mostraron una mejora en el LVEF después de la CABG, a diferencia de aquellos con respuesta DBP anormal persistente.
Conclusiones:
- Un aumento anormal de la PBC durante el ejercicio puede ser un marcador de enfermedad arterial coronaria significativa, particularmente en pacientes con cambios no diagnósticos en el ECG.
- Esta respuesta anormal puede identificar a los pacientes con alto riesgo de infarto de miocardio que de otro modo podrían ser subestimados.
- La respuesta de DBP al ejercicio es un indicador potencialmente valioso y no invasivo de la isquemia cardíaca y el pronóstico.
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