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Reactividad vascular pulmonar y pronóstico en pacientes con hipertensión pulmonar tromboembólica crónica: un estudio

Nika Skoro-Sajer¹, Niklas Hack, Roela Sadushi-Koliçi

¹Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.

|January 2, 2009

Resumen

La vasoreactividad aguda predice los resultados en pacientes con hipertensión pulmonar tromboembólica crónica sometidos a endarterectomía pulmonar. Una disminución de la presión arterial pulmonar media por encima del 10,4% con óxido nítrico indica una mejor supervivencia y evita el trasplante de pulmón.

Área de la Ciencia:

Cardiología Cardiología.
Pulmonología Pulmonología.
Cirugía torácica cirugía torácica.

Sus antecedentes:

La endarterectomía pulmonar es el tratamiento primario para la hipertensión pulmonar tromboembólica crónica (CTEPH).
La hipertensión pulmonar persistente después de la cirugía está relacionada con los malos resultados de los pacientes.
Es crucial predecir qué pacientes con CTEPH desarrollarán hipertensión pulmonar persistente o recurrente.

Objetivo del estudio:

Para determinar si las pruebas de vasoreactividad aguda pueden identificar a los pacientes CTEPH en riesgo de hipertensión pulmonar persistente / recurrente después de la cirugía.
Evaluar si el grado de vasoreactividad aguda afecta la supervivencia a largo plazo y la necesidad de trasplante de pulmón.

Principales métodos:

103 pacientes con CTEPH se sometieron a cateterismo cardíaco del lado derecho con y sin óxido nítrico (NO) inhalado.
Se midieron los cambios en la presión arterial pulmonar media (mPAP) y la resistencia vascular pulmonar.
Los pacientes fueron seguidos después de la endarterectomía pulmonar para evaluar los resultados.

Principales resultados:

El NO inhalado indujo reducciones significativas en la mPAP y la resistencia vascular pulmonar.
Una reducción en la mPAP superior al 10,4% con NO predijo mejores resultados postoperatorios.
El cambio en la mPAP durante la inhalación de NO fue un predictor significativo de la hipertensión pulmonar persistente / recurrente.

Conclusiones:

El 77,7% de los pacientes mostró algún grado de reactividad vascular pulmonar aguda.
Una disminución de >10.4% en mPAP con NO inhalado es un fuerte predictor de supervivencia a largo plazo.
Esta prueba de vasoreactividad ayuda a identificar a los pacientes con CTEPH que tendrán mejores resultados después de la endarterectomía pulmonar, reduciendo la necesidad de trasplante de pulmón.

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