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Patrones de dolor en el pecho y función microvascular coronaria en la enfermedad coronaria no obstructiva
Kai Nogami1, Yoshihisa Kanaji2, Takumi Toya3
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
Resumen
Los pacientes con dolor torácico por esfuerzo (PC) y disfunción microvascular coronaria (DMC) tienen una peor función microvascular. La CMD independiente del endotelio afecta significativamente el pronóstico en pacientes con parálisis cerebral por esfuerzo, lo que sugiere tratamientos dirigidos.
Área de la Ciencia:
- Cardiología
- Medicina vascular
- Imágenes de diagnóstico
Sus antecedentes:
- La disfunción microvascular coronaria (DMC) es una causa primaria de dolor en el pecho (PC) en pacientes con angina y arterias coronarias no obstructivas (ANOCA).
- La relación precisa entre los patrones de CMD y las características de CP en pacientes con ANOCA sigue sin estar clara.
Objetivo del estudio:
- Investigar la asociación entre la CMD y los distintos patrones de CP (exercicio versus reposo) en pacientes con ANOCA.
- Evaluar el significado pronóstico de estas asociaciones.
Principales métodos:
- 1.264 pacientes de ANOCA se sometieron a pruebas de reactividad coronaria.
- Los patrones de dolor en el pecho se clasificaron como esfuerzo, reposo o ambos.
- La CMD dependiente del endotelio y la independiente se evaluaron mediante la infusión intracoronaria de acetilcolina y de adenosina, respectivamente.
Principales resultados:
- En comparación con los pacientes con CP en reposo, los pacientes con CP en reposo presentaron una menor reserva de flujo coronario (CFR) y tasas más altas de CMD independientes del endotelio.
- Se observó una respuesta significativamente reducida del flujo sanguíneo coronario (FCB) a la acetilcolina en pacientes con parálisis cerebral por esfuerzo.
- La CMD independiente del endotelio se relacionó con un mayor riesgo de mortalidad en pacientes con parálisis cerebral por esfuerzo, pero no en pacientes con parálisis cerebral en reposo durante un seguimiento de 7 años.
Conclusiones:
- La PC por esfuerzo en pacientes con ANOCA se asocia con una función microvascular más pobre en comparación con la PC en reposo.
- La CMD independiente del endotelio tiene implicaciones pronósticas significativas para los pacientes con PC por esfuerzo.
- Las estrategias terapéuticas dirigidas para la CMD pueden ser particularmente beneficiosas para los pacientes con ANOCA que experimentan PC por esfuerzo.
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