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Prevalencia e importancia de la disfunción microvascular coronaria en pacientes con insuficiencia cardíaca y fracción
Charlotte Nordberg Backelin1,2, Sara Svedlund2, Entela Bollano3,2
1Cardiology Department, Sahlgrenska University Hospital, Gothenburg, Sweden charlotte.backelin@vgregion.se.
Open heart
|September 5, 2025
Resumen
La disfunción microvascular coronaria (DMC) afecta a dos tercios de los pacientes con insuficiencia cardíaca con fracción de eyección reducida (HFrEF) o fracción de eyección ligeramente reducida (HFmrEF). Los marcadores de la gravedad de la insuficiencia cardíaca, como la reducción de la tensión longitudinal global (GLS), están relacionados con la CMD.
Área de la Ciencia:
- Cardiología
- Investigación cardiovascular
- Investigación de la insuficiencia cardíaca
Sus antecedentes:
- La disfunción microvascular coronaria (DMC) se reconoce cada vez más en la insuficiencia cardíaca.
- Su prevalencia y su asociación con la gravedad de la insuficiencia cardíaca en pacientes con fracción de eyección reducida o ligeramente reducida (HFrEF/ HFmrEF) requieren una investigación adicional.
Objetivo del estudio:
- Determinar la prevalencia de CMD en pacientes con HFrEF/HFmrEF.
- Evaluar la asociación entre la CMD y los indicadores de gravedad de la insuficiencia cardíaca.
Principales métodos:
- Para medir la reserva de flujo coronario (CFR) se utilizó la ecocardiografía, incluido el Doppler transtorácico basado en adenosina.
- La CMD fue diagnosticada con un CFR < 2,5.
- Los análisis de regresión multivariables exploraron las asociaciones entre CFR, CMD y datos clínicos/biomarcadores.
Principales resultados:
- Se identificó CMD en el 66% de los pacientes con HFrEF/HFmrEF elegibles.
- Los pacientes con CMD presentaron puntuaciones más altas de NT-proBNP y hsTroponin-T, y más bajas en el Cuestionario de Cardiomiopatía de Kansas City (KCCQ).
- La reducción de la tensión longitudinal global (GLS) en los ventrículos izquierdo y derecho y en la aurícula izquierda se asoció con una menor presencia de CFR y CMD.
Conclusiones:
- La CMD tiene una alta prevalencia en pacientes con HFrEF/HFmrEF.
- Los marcadores de la gravedad de la insuficiencia cardíaca, incluido el GLS y los biomarcadores (NT-proBNP, hsTroponin-T), se asocian de forma independiente con la CMD.
- Estos hallazgos resaltan la importancia de evaluar la función microvascular en el tratamiento de la insuficiencia cardíaca.
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