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Cicatrización del miocardio y mortalidad en estenosis aórtica grave

Tarique A Musa¹, Thomas A Treibel², Vassiliou S Vassiliou³

¹Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, UK (T.A.M., L.E.D., J.R.J.F., P.B., G.R.L., J.P.G.).

|July 14, 2018

Resumen

La cicatriz miocárdica focal detectada por resonancia magnética cardiovascular en pacientes con estenosis aórtica severa predice de forma independiente la mortalidad a largo plazo. Esta presencia de cicatrices duplica el riesgo de mortalidad tardía, independientemente del tipo de reemplazo de válvula aórtica.

Área de la Ciencia:

Cardiología
Imágenes cardiovasculares
Cirugía cardíaca

Sus antecedentes:

El reemplazo de la válvula aórtica (AVR) para la estenosis aórtica suele ser cronometrado por el desarrollo de síntomas.
La AVR tardía puede conducir a una disfunción miocárdica irreversible y a un mayor riesgo quirúrgico.
La evaluación preoperatoria de la salud del miocardio es crucial para optimizar el tiempo quirúrgico y los resultados del paciente.

Objetivo del estudio:

Investigar la asociación entre la cicatriz miocárdica focal preoperatoria y la mortalidad a largo plazo en pacientes con estenosis aórtica grave.
Determinar si los patrones de cicatrización del miocardio y la carga predicen la mortalidad independientemente de otros factores de riesgo.

Principales métodos:

Un estudio longitudinal de resultados observacionales en el que participaron 674 pacientes con estenosis aórtica grave sometidos a AVR.
Se utilizó la resonancia magnética cardiovascular (RMA) previa al procedimiento para cuantificar la cicatriz miocárdica (patrones de infarto y no infarto).
Se realizó un análisis de supervivencia para realizar un seguimiento de la mortalidad por todas las causas y la mortalidad cardiovascular durante una mediana de seguimiento de 3,6 años.

Principales resultados:

La cicatriz miocárdica estuvo presente en el 51% de los pacientes (18% de infarto, 33% de patrón no infarto).
La presencia de cicatrices predijo de forma independiente la mortalidad por todas las causas (HR 2,39) y la mortalidad cardiovascular (HR 2,64).
Cada aumento del 1% en la carga cicatricial se asoció con un riesgo un 11% mayor de mortalidad por cualquier causa y un riesgo un 8% mayor de mortalidad cardiovascular.

Conclusiones:

La mejora tardía del gadolinio en la RMC, que indica una cicatriz miocárdica, es un predictor independiente de la mortalidad en la estenosis aórtica grave.
La presencia de cicatrices miocárdicas está asociada con un riesgo de mortalidad tardía dos veces mayor.
Estos hallazgos ponen de relieve la importancia de evaluar la cicatriz miocárdica en pacientes con estenosis aórtica grave para refinar la estratificación del riesgo y la toma de decisiones quirúrgicas.

Palabras clave:

Estenosis de la válvula aórtica imágenes por resonancia magnética la mortalidad Miocardio

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