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La incompetencia cronotrópica durante el ejercicio o el estrés farmacológico se asocia con una reducción de la

Lauro Cortigiani1, Quirino Ciampi2, Angela Zagatina3

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La incompetencia cronotrópica (IC), un signo de disfunción autónoma, aumenta significativamente el riesgo de mortalidad a los 10 años en pacientes con síndrome coronario crónico. Este simple resultado de la prueba de esfuerzo es un predictor independiente de la supervivencia.

Palabras clave:
La ecocardiografíaLa frecuencia cardíacaEl pronósticoEl estrésIncompetencia cronotrópica

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Área de la Ciencia:

  • Cardiología
  • Función del sistema nervioso autónomo
  • La ecocardiografía

Sus antecedentes:

  • La incompetencia cronotrópica (IC) es un biomarcador reconocido para la disfunción autónoma cardíaca.
  • La evaluación del valor pronóstico de la IC en los síndromes coronarios crónicos (SCC) es crucial para la estratificación del riesgo.

Objetivo del estudio:

  • Evaluar la capacidad de estratificación de riesgo de la IC detectada durante la ecocardiografía de esfuerzo en pacientes con SCC.
  • Determinar si la IC predice la mortalidad a largo plazo en esta población de pacientes.

Principales métodos:

  • Un estudio prospectivo, internacional y observacional en el que participaron 13.445 pacientes con SCC sometidos a una ecocardiografía de esfuerzo (ejercicio, dobutamina o dipiridamol).
  • El IC fue definido por criterios específicos de frecuencia cardíaca basados en el factor de estrés utilizado.
  • La muerte por todas las causas fue el objetivo primario, con una mediana de seguimiento de 3,4 años.

Principales resultados:

  • La IC estuvo presente en el 38% de los pacientes y se asoció con una mortalidad significativamente mayor a los 10 años (39% frente a 21%, P < 0,0001).
  • CI predicción independiente de la mortalidad (RH: 1,60) en todos los grupos de edad e independientemente del uso de betabloqueantes.
  • La IC fue identificada como un predictor independiente de la mortalidad junto con factores como la edad, el sexo y la fracción de eyección ventricular izquierda.

Conclusiones:

  • La incompetencia cronotrópica identificada durante la ecocardiografía de estrés es un predictor simple y objetivo de la supervivencia en pacientes con síndromes coronarios crónicos.
  • El CI proporciona información pronóstica valiosa para la estratificación del riesgo en pacientes con CCS.