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El deterioro de las reservas cronotrópicas y vasodilatadoras limita la capacidad de ejercicio en pacientes con
Barry A Borlaug1, Vojtech Melenovsky, Stuart D Russell
1Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA.
Circulation
|November 8, 2006
Resumen
Los pacientes con insuficiencia cardíaca con fracción de eyección preservada (HFpEF) presentan una reducción de la capacidad de ejercicio debido a una disminución de la reserva de salida crónotrópica, vasodilatadora y cardíaca, no solo a la disfunción diastólica.
Área de la Ciencia:
- Cardiología Cardiología.
- Fisiología del ejercicio Fisiología del ejercicio
- Investigación de la insuficiencia cardíaca Investigación de la insuficiencia cardíaca.
Sus antecedentes:
- La insuficiencia cardíaca con fracción de eyección preservada (HFpEF) afecta a casi la mitad de los pacientes con insuficiencia cardíaca.
- Los síntomas como la intolerancia al ejercicio a menudo se atribuyen a la disfunción diastólica.
- El deterioro de la reserva vasodilatadora sistólica o arterial bajo estrés también puede contribuir significativamente.
Objetivo del estudio:
- Para investigar la función cardiovascular del ejercicio en pacientes con HFpEF en comparación con los controles.
- Identificar las limitaciones fisiológicas específicas que contribuyen a la reducción de la capacidad de ejercicio en HFpEF.
- Explorar posibles objetivos terapéuticos para mejorar la tolerancia al ejercicio en HFpEF.
Principales métodos:
- Diecisiete pacientes con HFpEF y diecinueve sujetos de control se sometieron a ergometría de ciclo vertical de esfuerzo máximo.
- La ventriculografía de radionucleidos se utilizó para evaluar el descanso y el ejercicio de la función cardiovascular.
- Los sujetos fueron emparejados por edad, género y comorbilidades comunes como hipertensión y diabetes.
Principales resultados:
- Los pacientes con HFpEF demostraron una reducción significativa de la duración del ejercicio y el consumo máximo de oxígeno en comparación con los controles.
- En cargas de trabajo emparejadas, los pacientes con HFpEF mostraron aumentos contundentes en la frecuencia cardíaca y el rendimiento cardíaco, y menos vasodilatación.
- A pesar del volumen y la contractilidad diastólicos finales similares, los pacientes con HFpEF tenían una reserva crónotrópica y vasodilatadora deteriorada.
Conclusiones:
- Los pacientes con HFpEF muestran una disminución de la reserva cronotrópica, vasodilatadora y de salida cardíaca durante el ejercicio.
- Estas limitaciones no se deben únicamente a anomalías diastólicas.
- Estos hallazgos sugieren nuevos objetivos terapéuticos para mejorar la capacidad de ejercicio en HFpEF.
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