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Síncope y riesgo de muerte súbita en la cardiomiopatía hipertrófica
Paolo Spirito1, Camillo Autore, Claudio Rapezzi
1Divisione di Cardiologia, Ente Ospedaliero Ospedali Galliera, Via Volta 8, Genova 16128, Italy. paolo.spirito@galliera.it
Circulation
|March 25, 2009
Resumen
El síncope inexplicable en pacientes con cardiomiopatía hipertrófica es un factor de riesgo para la muerte súbita, especialmente cuando ocurre cerca de la evaluación. El síncope remoto en pacientes mayores no aumenta este riesgo.
Área de la Ciencia:
- Cardiología Cardiología.
- La medicina clínica es la medicina clínica.
- La muerte súbita por enfermedad cardíaca.
Sus antecedentes:
- La importancia pronóstica del síncope en la cardiomiopatía hipertrófica (CMH) está poco estudiada.
- Las actuales estrategias de tratamiento de la CMH para el síncope se basan en la experiencia más que en la evidencia.
Objetivo del estudio:
- Investigar la relación entre síncope y muerte súbita en una gran cohorte de pacientes con CMH.
- Para identificar las características específicas de síncope asociadas con un mayor riesgo de muerte súbita en HCM.
Principales métodos:
- Se evaluó síncope y muerte súbita en 1511 pacientes con CMH consecutivos.
- Síncope categorizado como inexplicable o neuralmente mediado.
- Se utilizó un análisis multivariable para determinar los factores de riesgo de muerte súbita, centrándose en la proximidad temporal del síncope.
Principales resultados:
- El síncope inexplicable ocurrió en el 14% de los pacientes; el síncope neuralmente mediado en el 3,4%.
- El síncope inexplicable mostró una tendencia hacia un mayor riesgo de muerte súbita (RR 1.78, P=0.08).
- El síncope dentro de los 6 meses de la evaluación aumentó significativamente el riesgo de muerte súbita (AHR 4.89), especialmente en pacientes más jóvenes. El síncope remoto en pacientes mayores no elevó el riesgo.
Conclusiones:
- El síncope inexplicable es un factor de riesgo significativo para la muerte súbita en la cardiomiopatía hipertrófica.
- El momento de los eventos sincopales inexplicables en relación con la evaluación clínica es crítico para la estratificación del riesgo.
- Los pacientes mayores con CMH con episodios remotos de síncope no enfrentan un mayor riesgo de muerte súbita.
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