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La cardiomiopatía hipertrófica es predominantemente una enfermedad del tracto de salida del ventrículo izquierdo
Martin S Maron1, Iacopo Olivotto, Andrey G Zenovich
1Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts-New England Medical Center, Boston, MA 02111, USA. mmaron@tufts-nemc.org
Circulation
|November 8, 2006
Resumen
La cardiomiopatía hipertrófica (HCM) es a menudo una enfermedad obstructiva, con el 70% de los pacientes que muestran obstrucción del flujo de salida del ventrículo izquierdo (LV). La ecocardiografía de ejercicio es crucial para identificar la obstrucción y guiar el tratamiento en pacientes con CMH.
Área de la Ciencia:
- Cardiología Cardiología.
- Medicina Cardiovascular La medicina cardiovascular es una especialidad de la salud.
- La ecocardiografía clínica es una ecocardiografía clínica.
Sus antecedentes:
- La cardiomiopatía hipertrófica (HCM) es tradicionalmente vista como no obstructiva basada en gradientes de reposo.
- Las evaluaciones anteriores subestimaron la prevalencia de la obstrucción del tracto de salida del ventrículo izquierdo (LV).
Objetivo del estudio:
- Para determinar prospectivamente la prevalencia y la importancia clínica de la obstrucción del tracto de salida de LV en una gran cohorte de HCM.
- Para evaluar la obstrucción en reposo y durante el estrés fisiológico (ejercicio).
Principales métodos:
- Análisis prospectivo de 320 pacientes con CMH.
- Medición de los gradientes de flujo de salida de LV en reposo, durante la maniobra de Valsalva y con ecocardiografía de ejercicio.
Principales resultados:
- El 70% de los pacientes (225/320) exhibieron obstrucción del flujo de salida de LV en reposo y/o con ejercicio.
- El ejercicio reveló obstrucción en 106 pacientes (53%) que previamente mostraban gradientes mínimos de reposo.
- La maniobra de Valsalva subestimó la obstrucción inducida por el ejercicio.
Conclusiones:
- HCM es predominantemente una enfermedad obstructiva, con obstrucción evidente en la mayoría de los pacientes evaluados.
- La ecocardiografía de ejercicio es vital para identificar la obstrucción, a menudo relacionada con los síntomas de insuficiencia cardíaca.
- Se recomienda la evaluación de rutina de los gradientes subaórticos durante el ejercicio para pacientes con CMH sin obstrucción en reposo.
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