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Caracterización del miocardio ventricular izquierdo en la esclerosis sistémica
Briella K Egberts1,2,3, Rajiv Ananthakrishna1,2,3,4,5, Ranjit Shah1,2,3
1College of Medicine and Public Health, Flinders University, Bedford Park 5042, Australia.
Journal of clinical medicine
|August 28, 2025
Resumen
Los pacientes con esclerosis sistémica sin enfermedad cardíaca presentan isquemia ventricular izquierda subclínica y deterioro de la respuesta de oxigenación al estrés. Esto sugiere que la disfunción microvascular coronaria temprana y la fibrosis contribuyen al riesgo cardiovascular.
Área de la Ciencia:
- Cardiología
- Radiología
- Reumatología
Sus antecedentes:
- La participación cardíaca es común en la esclerosis sistémica (SSc), pero los mecanismos de isquemia del ventrículo izquierdo (LV) no están claros.
- Se reconoce la hipertensión arterial pulmonar (HAP), sin embargo, la isquemia de LV requiere una investigación adicional.
- La resonancia magnética cardiovascular sensible al oxígeno (OS-CMR) ofrece nuevos conocimientos sobre la oxigenación del miocardio y la isquemia.
Objetivo del estudio:
- Evaluar los cambios en la desoxigenación miocárdica utilizando LV OS-CMR en pacientes con SSc sin enfermedad cardíaca conocida.
- Evaluar la participación cardíaca subclínica en SSc utilizando técnicas avanzadas de CMR.
- Para investigar la disfunción microvascular coronaria temprana y la fibrosis miocárdica de LV en SSc.
Principales métodos:
- Reclutamiento prospectivo de pacientes con SSc y voluntarios sanos de la misma edad y sexo.
- Resonancia magnética cardiovascular integral (CMR) que incluye el mapeo nativo de T1, el reposo / estrés OS-CMR, la perfusión de estrés y la mejora tardía del gadolinio (LGE).
- Ecocardiografía transtorácica (ETT) para evaluar la función cardíaca.
Principales resultados:
- Los pacientes con SSc mostraron una intensidad de señal LV OS-CMR global significativamente menor en comparación con los HV (p=0, 011).
- El 87% de los pacientes con SSc mostraron una disminución de la respuesta de oxigenación miocárdica (cambio de SI OS-CMR ≤10%) en al menos un segmento.
- Se observó una reducción de la tensión longitudinal global de LV (p=0,045) y evidencia de fibrosis difusa (mapeo T1 anormal en el 78%) en pacientes con SSc.
Conclusiones:
- Los pacientes con SSc sin enfermedad cardiovascular conocida o HAP muestran isquemia LV subclínica y deterioro de la oxigenación miocárdica inducida por el estrés.
- Las anomalías de la deformación del miocardio LV y la fibrosis difusa están presentes en los pacientes con SSc en comparación con los controles.
- Los hallazgos sugieren que la disfunción microvascular coronaria temprana y la fibrosis de LV contribuyen al riesgo cardiovascular en SSc, independientemente de la HAP.
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