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Pérdida del cromosoma Y y eventos cardiovasculares en la enfermedad renal crónica
Michael Weyrich1, Sebastian Cremer2,3, Martin Gerster4
11Goethe University Frankfurt's University Hospital, Department of Internal Medicine 4, Nephrology (T.S., S.R.P., M.G., T.S., M.W.).
Circulation
|July 15, 2024
Resumen
La pérdida mosaica del cromosoma Y (LOY) en hombres con enfermedad renal crónica está relacionada con una mayor mortalidad e insuficiencia cardíaca. Este hallazgo identifica un factor de riesgo clave para los resultados cardiovasculares adversos en esta población de pacientes.
Área de la Ciencia:
- Nefrología
- Cardiología
- La genética
Sus antecedentes:
- La enfermedad renal crónica (ERC) es un factor de riesgo importante para las enfermedades cardiovasculares, especialmente la insuficiencia cardíaca, con altas tasas de mortalidad.
- Los estudios experimentales sugieren que la pérdida de mosaico del cromosoma Y (LOY) está asociada con la fibrosis cardíaca en ratones machos.
- La fibrosis cardíaca es una vía común en la progresión de la insuficiencia cardíaca.
Objetivo del estudio:
- Investigar la asociación entre la pérdida de mosaico del cromosoma Y (LOY) y los resultados de mortalidad y enfermedad cardiovascular en pacientes varones con ERC.
- Para determinar si LOY puede identificar pacientes con mayor riesgo de eventos cardíacos adversos.
Principales métodos:
- LOY cuantificada en hombres con ERC estable (estudio CARE for HOMe, n=279) y pacientes en diálisis (estudio 4D, n=544).
- Se evaluó la asociación entre la LOY y la mortalidad, los puntos finales cardiovasculares y cardíacos específicos combinados, y las medidas ecocardiográficas.
Principales resultados:
- En ambas cohortes, LOY > 17% se asoció significativamente con un aumento de la mortalidad por cualquier causa y un mayor riesgo de eventos de insuficiencia cardíaca.
- Los pacientes con LOY > 17% mostraron disminución de la fracción de eyección y aumento de los marcadores de fibrosis miocárdica (soluble como receptor de interleucina 1).
- Los conocimientos mecánicos sugieren que el aumento de la expresión de los receptores de quimiocinas C-C monocitos tipo 2 en pacientes con LOY puede contribuir a la insuficiencia cardíaca.
Conclusiones:
- La pérdida mosaica del cromosoma Y (LOY) es un predictor significativo de la mortalidad y los eventos de insuficiencia cardíaca en pacientes masculinos con ERC.
- LOY puede identificar a los pacientes masculinos con ERC en alto riesgo de resultados cardiovasculares adversos, incluida la insuficiencia cardíaca.
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